An encephalocele as a complication of mastoid surgery. (Imaging Clinic).Otolaryngologists have described brain herniation into the mastoid for many years. Although this condition can develop as a result of congenital defects, encephaloceles can also occur postsurgically. Advances in neuroradiology, such as computed tomography (CT) and magnetic resonance imaging magnetic resonance imaging (MRI), noninvasive diagnostic technique that uses nuclear magnetic resonance to produce cross-sectional images of organs and other internal body structures. (MRI), have improved the diagnosis and management of lesions that erode the tegmen tegmen /teg·men/ (teg´men) pl. teg´mina [L.] a covering structure or roof. tegmen tym´pani tympani. (1) The diagnosis of brain herniation should be suspected in any patient who has a history of complicated chronic ear surgery in addition to a slowly developing pulsatile pulsatile /pul·sa·tile/ (pul´sah-til) characterized by a rhythmic pulsation. pul·sa·tile adj. Undergoing pulsation. pulsatile characterized by a rhythmic pulsation. mass and cerebrospinal fluid (CSF) leak. We evaluated a 51-year-old man whose chief complaint was a sensation of fullness in his right ear. The patient had undergone several previous surgeries for chronic mastoiditis mastoiditis Inflammation of the mastoid process, a bony projection just behind the ear, almost always due to otitis media. It may spread into small cavities in the bone, blocking their drainage. Very severe cases infect the whole middle ear cleft. on the right. He also complained of chronic headaches and intermittent drainage of the right ear. CT identified a bone defect in the tegmen tympani and a soft-tissue mass in the area of the mastoidectomy Mastoidectomy Definition Mastoidectomy is a surgical procedure to remove an infected portion of the bone behind the ear when medical treatment is not effective. This surgery is rarely needed today because of the widespread use of antibiotics. and middle ear cavity, which was thought to represent a recurrent cholesteatoma (figure, A). MRI clearly demonstrated that the mass represented a brain herniation through the tegmen tympani (figure, B). Surgical exploration with a right temporal craniotomy Craniotomy Definition Surgical removal of part of the skull to expose the brain. Purpose A craniotomy is the most commonly performed surgery for brain tumor removal. was performed, and the presence of an encephalocele was confirmed The encephalocele and the CSF leak were subsequently repaired. Reference (1.) Bowes AK, Wiet RJ, Monsell EM, et al. Brain herniation and space-occupying lesions eroding the tegmen tympani. Laryngoscope 1987;97:1172-5. From the Department of Radiology, Louisiana State University Health Science Center, New Orleans. |
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