Clinical and radiologic sequelae of the middle fossa approach to the internal auditory canal.
OBJECTIVE
This retrospective study aimed to characterize the postoperative nonneurotologic complications and radiologic findings after the middle fossa approach to the internal auditory canal (IAC). A grading system for computed tomography (CT) changes was developed.


METHODS
Sixty-two patients operated between 2000 and 2003 had CT scans of the head on the day after surgery. Their charts and films were reviewed.


METHODS
R15 DK 54070-01A1: Tertiary referral center.


RESULTS
Nine patients had complications, including seven with cerebrospinal fluid leakage, one with infection, and one with visual disturbances. Only three of these patients had CT changes. Alternatively, 14 patients had CT changes according to our grading system for edema, pneumatocephalus, and hematoma. Three of these patients had complications. The overall complication rate was low (15%), and there were no cases of serious damage to the temporal lobe.


CONCLUSIONS
The middle fossa approach provides safe access to the IAC. With the use of flexible retractors, serious damage to the temporal lobe can be avoided. The CT scan on the first day after surgery is useful for detecting dangerous hematomas but should be correlated to the patient's condition because of non-specific radiologic changes and the potential for complications to be present even in the absence of CT findings.
Stripf
Tobias
T
Ear, Nose, and Throat Department, University Mainz Medical School, Mainz, Germany. stripf@hno.klinik.uni-mainz.de
Bruehl
Klaus
K
Mann
Wolf J
WJ
Amedee
Ronald G
RG
D000293:Adolescent; D000328:Adult; D000368:Aged; D002558:Cerebrospinal Fluid Otorrhea / Q000000981:diagnostic imaging / Q000209:etiology / Q000628:therapy; D002559:Cerebrospinal Fluid Rhinorrhea / Q000000981:diagnostic imaging / Q000209:etiology / Q000628:therapy; D035301:Cranial Fossa, Middle / Q000601:surgery; D003399:Craniotomy / Q000009:adverse effects; D004424:Ear Canal / Q000601:surgery*; D004428:Ear Neoplasms / Q000601:surgery; D004487:Edema / Q000000981:diagnostic imaging; D006406:Hematoma / Q000000981:diagnostic imaging; D006801:Humans; D008875:Middle Aged; D009367:Neoplasm Staging; D011007:Pneumocephalus / Q000000981:diagnostic imaging; D011183:Postoperative Complications / Q000000981:diagnostic imaging* / Q000628:therapy; D012189:Retrospective Studies; D019291:Skull Base / Q000000981:diagnostic imaging*; D013702:Temporal Lobe / Q000000981:diagnostic imaging / Q000293:injuries; D014057:Tomography, X-Ray Computed / Q000379:methods