Lateral semicircular canal fistula in cholesteatoma: diagnosis and management
Lateral semicircular canal fistula in cholesteatoma: diagnosis and management
复制标题
DOI：
10.1007/s00405-015-3775-6
复制
发表时间：
2016-08-01
影响因子：
2.6
通讯作者：
Marie, Jean-Paul
中科院分区：
文献类型：
--
作者：
Meyer, Anais;Bouchetemble, Pierre;Marie, Jean-Paul
本回顾性研究的目的是介绍作者对胆脂瘤继发迷路瘘的处理经验。本研究回顾了1993年至2013年间在某大学医院接受胆脂瘤鼓室成形术治疗的695例患者，仅选择了那些患有迷路瘘的患者。42例（6%）胆脂瘤合并外侧半规管瘘。收集以下数据点：症状、术前和术后临床体征、外科医生、CT扫描诊断、瘘类型、手术技术、术前前庭功能和听力学结果。最常见的症状是不明确的，如耳漏、听力丧失和头晕。然而，术前高分辨率计算机断层扫描预测瘘管的比例为88%。使用Dornhoffer和milowski分类，16例（38%）被确定为1期，22例（52%）被确定为II期，4例（10%）被确定为III期。选择开放式或闭合性手术与瘘管类型无关。胆脂瘤基质完全从瘘管中移除，并立即被自体材料覆盖。在8例（19%）患者中，在用自体组织封闭之前，先用金刚石毛刺钻管。手术后，76%的患者听力得到保留或改善。迷路瘘的范围与听力结果之间无统计学意义的关系。总之，在一期手术中，完全和非创伤性地切除瘘上的基质胆脂瘤，并用骨粉和颞筋膜将其封闭，有时排除LSCC，是一种安全有效的治疗迷路瘘的方法。
The objective of this retrospective study was to present the authors' experience on the management of labyrinthine fistula secondary to cholesteatoma. 695 patients, who underwent tympanoplasty for cholesteatoma, in a University Hospital between 1993 and 2013 were reviewed, to select only those with labyrinthine fistulas. 42 patients (6%) had cholesteatoma complicated by fistula of the lateral semicircular canal (LSCC). The following data points were collected: symptoms, pre- and postoperative clinical signs, surgeon, CT scan diagnosis, fistula type, surgical technique, preoperative vestibular function and audiometric outcomes. Most frequent symptoms were unspecific, such as otorrhea, hearing loss and dizziness. However, preoperative high-resolution computed tomography predicted fistula in 88 %. Using the Dornhoffer and Milewski classification, 16 cases (38 %) were identified as stage 1, 22 (52 %) as stage II, and 4 (10 %) as stage III. The choice between open or closed surgical procedure was independent of the type of fistulae. The cholesteatoma matrix was completely removed from the fistula and immediately covered by autogenous material. In eight patients (19 %), the canal was drilled with a diamond burr before sealing with autologous tissue. After surgery, hearing was preserved or improved in 76 % of the patients. There was no statistically significant relationship between the extent of the labyrinthine fistula and the hearing outcome. In conclusion, a complete and nontraumatic removal of the matrix cholesteatoma over the fistula in a one-staged procedure and its sealing with bone dust and fascia temporalis, with sometimes exclusion of the LSCC, is a safe and effective procedure to treat labyrinthine fistula.