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Dura involvement and lateral skull base reconstruction in cholesteatoma surgery: a retrospective study

Presenting Author: Andreas Anagiotos

Published online by Cambridge University Press:  03 June 2016

Andreas Anagiotos ,
David Schwarz ,
Sami Shabli ,
Antoniu-Oreste Gostian  and
Karl-Bernd Hüttenbrink
Andreas Anagiotos
Affiliation:
Nicosia General Hospital & Larnaca General Hospital, Cyprus / University Hospital Of Cologne, Germany
David Schwarz
Affiliation:
University Hospital of Cologne, Germany
Sami Shabli
Affiliation:
University Hospital of Cologne, Germany
Antoniu-Oreste Gostian
Affiliation:
University Hospital of Cologne, Germany
Karl-Bernd Hüttenbrink
Affiliation:
University Hospital of Cologne, Germany
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Abstract

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Learning Objectives: - Dura involvement in cholesteatoma surgery is rare but possible. - Reconstruction of the lateral skull base can be performed using a variety of materials. - No intracranial complications are expected when dura involvement is recognized and treated properly.

Introduction: Due to its anatomical proximity to the tympanic cavity and the mastoid cells, the dura of the middle cranial fossa is occasionally involved in middle ear and mastoid surgery. This study investigates the frequency of dura involvement during cholesteatoma surgery in children and adult population.

Methods: A retrospective chart review of cholesteatoma surgeries between 2004 and 2015 at an academic tertiary care center was performed. Any kind of dura involvement, as well as the reconstruction techniques and long-term complications were documented.

Results: From 1291 cholesteatoma surgeries performed in the study period, a total of 97 (7.5 %) surgeries with dura involvement were identified. In the majority of these cases (n = 74, 5.7 %) the bone to the middle cranial fossa was missing and the otherwise intact dura was exposed. The dura was additionally damaged and cerebrospinal fluid leak was seen in six surgeries (0.5 %). In three cases (0.2 %) iatrogenic dura injury was reported, whereas in 9 surgeries (0.7 %) cholesteatoma came up to and infiltrated the dura. Reconstruction of the lateral skull base was performed using cartilage (n = 24, 1.9 %), polydioxanone (PDS)-foil (n = 14, 1.1 %), bone pate (n = 8, 0.6 %) and fibrin glue (n = 5, 0.4%). In 11 cases (0.9 %) a combination of autologous materials - such as cartilage, bone pate, muscle and connective tissue - was used, whereas in 33 surgeries (2,6 %) no reconstruction of the lateral skull base was performed. In a follow-up time period of 19.7 months (range 1 day - 104 months) no intracranial complications were reported.

Conclusions: The involvement of the dura of the middle cranial fossa is a rare but possible phenomenon during cholesteatoma surgery. A variety of reconstruction materials are available for the sufficient reconstruction of the skull base in such cases. When recognized and treated properly, no intracranial complications are expected, even in long term time period.