Deossification of the Otic Bone in High Pressure CSF Otorhinorrhea: A New Radiological Finding.
High pressure spontaneous cerebrospinal fluid otorhinorrhea
High resolution computed tomography
Labyrinthine malformation
Otic bone
Journal
Indian journal of otolaryngology and head and neck surgery : official publication of the Association of Otolaryngologists of India
ISSN: 2231-3796
Titre abrégé: Indian J Otolaryngol Head Neck Surg
Pays: India
ID NLM: 9422551
Informations de publication
Date de publication:
Sep 2020
Sep 2020
Historique:
received:
22
11
2019
accepted:
24
12
2019
entrez:
31
7
2020
pubmed:
31
7
2020
medline:
31
7
2020
Statut:
ppublish
Résumé
To highlight a new radiological feature in a patient with labyrinthine malformation presenting with bilateral spontaneous high pressure cerebrospinal fluid (CSF) otorhinorrhea. Study design-retrospective case review. Setting-academic, tertiary cochlear implant center. A cochlear implantee with Incomplete Partition Defect (Type 1) presented with meningitis and CSF otorhinorrhea for which she initially underwent medical treatment. High resolution computed tomography (HRCT) of the temporal bone with CT cisternography was performed for identifying the site of the CSF leak. HRCT and CT cisternography revealed a defect in the region of the stapes foot plate and marked thinning/deossification of the cochlear promontory. These two findings were absent in the pre-implant imaging of the patient done 3 years ago. Surgery by endaural approach was undertaken to close the site of CSF leak. Intraoperatively, marked thinning of the cochlear promontory was observed, corresponding to 'blue lining' of the labyrinth in otologic surgery. This intraoperative finding indicating high intralabyrinthine CSF pressure correlated well with the imaging findings. Primary surgical repair resulted in successful CSF leak closure followed by theco-peritoneal shunting to prevent recurrence of the leak. The patient is using her cochlear implant and doing well with auditory verbal therapy. She is asymptomatic till date. Thinning and deossification of the otic capsule on HRCT is an important indicator of high CSF pressure in patients with labyrinthine malformations. Our case study highlights the need for heightened radiological and clinical vigilance in this subgroup of patients to predict complications and ensure prompt intervention.
Identifiants
pubmed: 32728551
doi: 10.1007/s12070-019-01777-w
pii: 1777
pmc: PMC7374683
doi:
Types de publication
Journal Article
Langues
eng
Pagination
385-391Informations de copyright
© Association of Otolaryngologists of India 2020.
Déclaration de conflit d'intérêts
Conflict of interestThe authors declared that they have no conflict of interest.
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