Radiologic Findings after Transpromontorial Approach: Clinical and Pathophysiological Considerations.

IF 1.9 3区 医学 Q3 CLINICAL NEUROLOGY
Matteo Alicandri-Ciufelli, Edoardo Serafini, Maria Rosini, Carlotta Liberale, Francesca De Cecco, Elke Loos, Paolo Garofalo, Nicolò Cardobi, Alessia Rubini, Daniele Marchioni
{"title":"Radiologic Findings after Transpromontorial Approach: Clinical and Pathophysiological Considerations.","authors":"Matteo Alicandri-Ciufelli, Edoardo Serafini, Maria Rosini, Carlotta Liberale, Francesca De Cecco, Elke Loos, Paolo Garofalo, Nicolò Cardobi, Alessia Rubini, Daniele Marchioni","doi":"10.1097/MAO.0000000000004483","DOIUrl":null,"url":null,"abstract":"<p><strong>Objectives: </strong>Transpromontorial approaches require obliteration of the surgical cavity and the eustachian tube, along with cul-de-sac external auditory canal closure, without obliteration of the mastoid air cells. This study aims to evaluate the clinical and radiological implications of tympanic cavity obliteration when the mastoid air cell system is preserved.</p><p><strong>Study design: </strong>Retrospective observational study.</p><p><strong>Setting: </strong>Tertiary referral center.</p><p><strong>Patients: </strong>Thirty-one adult patients with unilateral vestibular schwannoma.</p><p><strong>Intervention: </strong>Patients underwent resection of a vestibular schwannoma through either an exclusive endoscopic transcanal transpromontorial approach (endoTTA) or an expanded transcanal transpromontorial approach (expTTA).</p><p><strong>Main outcome measure: </strong>Postoperative radiologic mastoid and surgical cavity content and clinical outcomes.</p><p><strong>Results: </strong>Thirty-one patients met the inclusion criteria. The mean radiological follow-up was 54 months. Regarding mastoid content, air was present in 13 patients (42%) and trapped fluid in 18 patients (58%). Surgical cavity content revealed air in 14 patients (45%), trapped fluid in 8 patients (26%), total fat obliteration in 5 patients (16%), and partial fat obliteration in 4 patients (13%). No cases of mucocele, cholesterol granuloma, or iatrogenic cholesteatoma were observed. Three main radiological patterns were identified by combining mastoid and surgical cavity findings. EndoTTA was found to be significantly associated with postoperative radiological air content in the mastoid cavity (p value = 0.013), while no association was found between the type of radiological pattern and the development of complications or symptoms at the last follow-up.</p><p><strong>Conclusions: </strong>EndoTTA and expTTA are safe and effective procedures, with no increased risk of meningitis or CSF leak, even in cases where obliteration tissue is reabsorbed.</p>","PeriodicalId":19732,"journal":{"name":"Otology & Neurotology","volume":" ","pages":""},"PeriodicalIF":1.9000,"publicationDate":"2025-02-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Otology & Neurotology","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1097/MAO.0000000000004483","RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q3","JCRName":"CLINICAL NEUROLOGY","Score":null,"Total":0}
引用次数: 0

Abstract

Objectives: Transpromontorial approaches require obliteration of the surgical cavity and the eustachian tube, along with cul-de-sac external auditory canal closure, without obliteration of the mastoid air cells. This study aims to evaluate the clinical and radiological implications of tympanic cavity obliteration when the mastoid air cell system is preserved.

Study design: Retrospective observational study.

Setting: Tertiary referral center.

Patients: Thirty-one adult patients with unilateral vestibular schwannoma.

Intervention: Patients underwent resection of a vestibular schwannoma through either an exclusive endoscopic transcanal transpromontorial approach (endoTTA) or an expanded transcanal transpromontorial approach (expTTA).

Main outcome measure: Postoperative radiologic mastoid and surgical cavity content and clinical outcomes.

Results: Thirty-one patients met the inclusion criteria. The mean radiological follow-up was 54 months. Regarding mastoid content, air was present in 13 patients (42%) and trapped fluid in 18 patients (58%). Surgical cavity content revealed air in 14 patients (45%), trapped fluid in 8 patients (26%), total fat obliteration in 5 patients (16%), and partial fat obliteration in 4 patients (13%). No cases of mucocele, cholesterol granuloma, or iatrogenic cholesteatoma were observed. Three main radiological patterns were identified by combining mastoid and surgical cavity findings. EndoTTA was found to be significantly associated with postoperative radiological air content in the mastoid cavity (p value = 0.013), while no association was found between the type of radiological pattern and the development of complications or symptoms at the last follow-up.

Conclusions: EndoTTA and expTTA are safe and effective procedures, with no increased risk of meningitis or CSF leak, even in cases where obliteration tissue is reabsorbed.

经前列腺入路后的放射学表现:临床和病理生理考虑。
目的:经鼻窦入路需要封堵手术腔和咽鼓管,同时封闭外耳道,但不封堵乳突空气细胞。本研究旨在评估保留乳突空气细胞系统时鼓室闭塞的临床和放射学意义。研究设计:回顾性观察性研究。单位:三级转诊中心。患者:成人单侧前庭神经鞘瘤31例。干预措施:患者接受前庭神经鞘瘤切除术,通过内镜下经鼻鼻经岬入路(endoTTA)或扩大经鼻鼻经岬入路(expTTA)。主要观察指标:术后乳突和手术腔放射学内容及临床结果。结果:31例患者符合纳入标准。平均放射随访54个月。关于乳突内容物,13例(42%)患者存在空气,18例(58%)患者存在积液。手术腔内容显示空气14例(45%),积液8例(26%),完全脂肪闭塞5例(16%),部分脂肪闭塞4例(13%)。没有观察到粘液囊肿、胆固醇肉芽肿或医源性胆脂瘤。通过结合乳突和手术腔的发现,确定了三种主要的放射学模式。EndoTTA与术后乳突腔内放射学空气含量显著相关(p值= 0.013),而末次随访时放射学类型与并发症或症状的发生无相关性。结论:EndoTTA和expTTA是安全有效的手术,即使在闭塞组织被重新吸收的情况下,也不会增加脑膜炎或脑脊液泄漏的风险。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
求助全文
约1分钟内获得全文 求助全文
来源期刊
Otology & Neurotology
Otology & Neurotology 医学-耳鼻喉科学
CiteScore
3.80
自引率
14.30%
发文量
509
审稿时长
3-6 weeks
期刊介绍: ​​​​​Otology & Neurotology publishes original articles relating to both clinical and basic science aspects of otology, neurotology, and cranial base surgery. As the foremost journal in its field, it has become the favored place for publishing the best of new science relating to the human ear and its diseases. The broadly international character of its contributing authors, editorial board, and readership provides the Journal its decidedly global perspective.
×
引用
GB/T 7714-2015
复制
MLA
复制
APA
复制
导出至
BibTeX EndNote RefMan NoteFirst NoteExpress
×
提示
您的信息不完整,为了账户安全,请先补充。
现在去补充
×
提示
您因"违规操作"
具体请查看互助需知
我知道了
×
提示
确定
请完成安全验证×
copy
已复制链接
快去分享给好友吧!
我知道了
右上角分享
点击右上角分享
0
联系我们:info@booksci.cn Book学术提供免费学术资源搜索服务,方便国内外学者检索中英文文献。致力于提供最便捷和优质的服务体验。 Copyright © 2023 布克学术 All rights reserved.
京ICP备2023020795号-1
ghs 京公网安备 11010802042870号
Book学术文献互助
Book学术文献互助群
群 号:481959085
Book学术官方微信