Analysis of the dura involvement in cholesteatoma surgery. Issue 1 (February 2018)

• Record Type: Journal Article
• Authors: Schwarz, David; Gostian, Antoniu-Oreste; Shabli, Sami; Wolber, Philipp; Hüttenbrink, Karl Bernd; Anagiotos, Andreas
• Is Part Of: Auris nasus larynx. Volume 45:Issue 1(2018)
• Page Start: 51
• Page End: 56
• Publication Date: 2018-02
• Subjects: Cholesteatoma -- Dura -- Middle cranial fossa -- Intracranial complications; Otolaryngology -- Periodicals; Electronic journals; 616
• DOI: 10.1016/j.anl.2017.02.010
• Languages: English
• ISSNs: 0385-8146

Abstract

Abstract: Objective: The involvement of the dura is a rare yet potentially life-threatening complication during cholesteatoma surgery. Thus, the knowledge about treatment and consequences of this issue is of great importance to every ear surgeon. Methods: This retrospective study analyzed the dura involvement with regard to the type of defect, reconstruction method used, and the post-operative complications of 1291 pediatric and adult cholesteatoma surgeries performed at an academic tertiary care center over a twelve-year period. Results: From a total of 1291 cholesteatoma surgeries, we identified 84 patients (6.5%) with dura involvement intraoperatively, most of them adult patients. The majority of the reported cases were bony defects and exposed dura without CSF leakage (79.73%, 67 out of 84). In 14.28% of the cases (12 out of 84) a meningo(encephalo)cele or dura defect with liquorrhea were detected. In 30 surgeries (35.7%, 30 out of 84) no reconstruction of the lateral skull base was considered necessary. The most common material used for reconstruction was conchal cartilage (25.0%, 21 out of 84), followed by polydioxanone (PDS)-foil (11.9%, 10 out of 84), bone pâté (9.5%, 8 out of 84) and a combination of materials (17.9%, 15 out of 84). Revision surgery of the reconstruction was necessary in 16.7% (14 out of 84) of the cases. Long-term evaluation (mean of 19.3 months) showed no complication related to the skull base defect. Conclusion: During cholesteatoma surgery, bony and dura defects can be managed effectively, with good long-term reliability. No intracranial or mastoidal complications are expected.