Outcomes after mini-craniotomy middle fossa approach combined with mastoidectomy for lateral skull base defects.
Outcomes after mini-craniotomy middle fossa approach combined with mastoidectomy for lateral skull base defects.
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DOI：
10.1016/j.amjoto.2020.102794
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发表时间：
2021-01
影响因子：
2.5
通讯作者：
Herzog J
中科院分区：
文献类型：
--
作者：
Walia A;Lander D;Durakovic N;Shew M;Wick CC;Herzog J
关于侧颅底缺损修复的理想入路存在争议。我们的目的是报告中颅窝（MCF）小骨瓣开颅术联合乳突切除术治疗上级半规管裂开（SSCD）、自发性脑脊液（CSF）漏和中耳乳突瘤患者的结局。通过病历审查形成了一个回顾性数据库，其中包括97例符合手术标准的患者：SSCD、自发性CSF泄漏和胆脂瘤。采用小骨窗MCF入路（<4 × 2cm）联合乳突切除术。所有患者术后直接入住ICU。评估了多个因素，包括翻修手术的需要、手术持续时间、术后住院时间和再次入院。平均手术时间为110分钟，无术中并发症。平均住院时间为2天，平均ICU停留时间为1天。无神经系统并发症;然而，有3例住院并发症（3%），包括1例患者（1%）伤口破裂和2例患者（2%）重度术后眩晕。共有8例患者（8%）需要翻修手术，主要用于SSCD。30天再入院率为3%。在当前系列中，所有接受小骨瓣MCF手术联合乳突切除术的患者并发症最少，手术时间短，住院时间短，翻修手术率低，再入院率低。这种联合入路提供了侧颅底缺损的上级可视化，而没有传统广泛MCF手术通常相关的发病率和风险。
Controversy exists regarding the ideal approach for repair of lateral skull base defects. Our goal is to report the outcomes following middle cranial fossa (MCF) mini-craniotomy combined with mastoidectomy for patients with superior semicircular canal dehiscence (SSCD), spontaneous cerebrospinal fluid (CSF) leak, and cholesteatoma. A retrospective database from chart review was formed consisting of 97 patients who met surgical criteria: SSCD, spontaneous CSF leak, and cholesteatoma. Mini-craniotomy MCF approach (<4 × 2 cm in size) combined with mastoidectomy was performed. All patients were admitted directly to the ICU postoperatively. Multiple factors were assessed, including need for revision surgery, duration of surgery, length of post-operative stay, and hospital readmission. Average surgery time was 110 minutes with no intraoperative complications. The average length of hospitalization was 2 days with an average ICU stay of 1 day. There were no neurologic complications; however, there were 3 inpatient complications (3%) which included 1 patient (1%) that had wound breakdown and 2 patients (2%) that had severe post-operative vertigo. A total of 8 patients (8%) required revision surgery and these were primarily for SSCD. The 30-day readmission rate was 3%. In the current series, all patients that underwent mini-craniotomy MCF surgery combined with mastoidectomy had minimal complications, short surgical time, limited hospital stay, low revision surgery rate and few hospital readmissions. This combined approach offers superior visualization of lateral skull base defects without the morbidity and risk typically associated with traditional, extensive MCF surgery.
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