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  • Title: Eustachian tube obliteration in translabyrinthine vestibular schwannoma excision: cerebrospinal fluid rhinorrhea and middle ear status.
    Author: Saliba I, Shinghal T, Nehme J, Dufour JJ.
    Journal: J Otolaryngol Head Neck Surg; 2011 Oct; 40(5):367-75. PubMed ID: 22420391.
    Abstract:
    OBJECTIVES: To assess the incidence of cerebrospinal fluid (CSF) rhinorrhea by systematic eustachian tube (ET) obliteration at the time of a translabyrinthine vestibular schwannoma (VS) excision and to evaluate its effect on the middle ear and on the tympanic membrane and if it is well tolerated by patients. STUDY DESIGN: Retrospective study. SETTING: Tertiary care centre. PATIENTS: Group 1 (57 patients) and group 2 (87 patients) underwent translabyrinthine VS excision with and without systematic ET obliteration, respectively. MAIN OUTCOME MEASURES: Petrous apex pneumatization level and postoperative CSF leak were evaluated. Group 1 patients had a late postoperative otologic examination, tympanometric test, Valsalva manoeuvre, and ear symptom evaluation. RESULTS: There were six cases of CSF rhinorrhea in group 2, whereas no cases were observed in group 1 (p  =  .043), despite its larger tumour grade (p  =  .002). In group 2, CSF rhinorrhea was absent at pneumatization level 1. Three of six CSF rhinorrhea cases developed meningitis. None of the 27 tested patients of group 1 demonstrated a tympanic membrane retraction or a positive Valsalva manoeuvre. Tympanometry showed a type A curve (2 patients), a type As curve (14 patients), and a type B curve (11 patients). Air volumes and air pressures of the operated ears were lower than those of the nonoperated ears (p < .001). CONCLUSION: Patients of group 1 tolerated the procedure well, with preserved tympanic membrane compliance. Bidirectional air exchange throughout a normal middle ear mucosa explains this fact. We recommend obliteration of both the petrous apex cells and ET in all cases of petrous apex pneumatization levels 2 to 4.
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