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Watanabe S, Schneider T, Amagasaki K, Nakaguchi H, Unterberg A, Dao Trong P. Differences in mastoid pneumatization between Asians and Caucasians. J Clin Neurosci 2023; 109:39-43. [PMID: 36709624 DOI: 10.1016/j.jocn.2023.01.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Revised: 01/13/2023] [Accepted: 01/18/2023] [Indexed: 01/29/2023]
Abstract
BACKGROUND Anatomical differences of the mastoid pneumatization in Asian and Caucasian patients must be considered when performing the retrosigmoid craniotomy since it may have implications to avoid specific complications such as cerebrospinal fluid infections or fistula. METHODS We selected cranial CT scans of 120 Asian and 120 Caucasian patients, who were treated at the Mitsui Memorial Hospital (Japan) and at the Heidelberg University Hospital (Germany). Mastoid pneumatization was classified according to the relationship of the mastoid air cells (MAC) to the sigmoid sinus (Type I - III). The risk of mastoid air cell opening through craniotomy increases from Type I to III. Comparative analyses between gender and ethnicities were performed using the Chi2 Test and the independent T-Test and considered significant if p < 0.05. RESULT In Caucasians, Type III pneumatization was significantly overrepresented compared to Type II or I, compared to the Asian cohort (Type III:II:I in Caucasians = 60 %:26 %:14 %; in Asians = 28 %:43 %:29 %). Importantly, we found significant differences in pneumatization types between Caucasians and Asians in both gender subgroups (m: Type III 60 % vs 35 %; Type II 30 % vs 36.7 %; Type I 10 % vs 28.3 %, p = 0.008; f: Type III 60 % vs 23.3 %, Type II 21.7 % vs 48.3 %, Type III 18.3 % vs 28.3 %, p < 0.001; Chi2 Test). CONCLUSION Caucasian patients are more prone to the opening of the mastoid air cells than Asian patients when performing a retrosigmoid craniotomy due to differences in the degree of mastoid pneumatization. This may help to avoid complications such as postoperative infections or cerebrospinal-fluid fistula.
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Affiliation(s)
- Saiko Watanabe
- Department of Neurosurgery, Heidelberg University Hospital, Im Neuenheimer Feld 400, 69117 Heidelberg, Germany
| | - Till Schneider
- Department of Neuroradiology, Heidelberg University Hospital, Im Neuenheimer Feld 400, 69117 Heidelberg, Germany.
| | - Kenichi Amagasaki
- Department of Neurosurgery, Mitsui Memorial Hospital, 101-8643 Tokyo, Chiyoda City, Kanda Izumicho, 1, Japan.
| | - Hiroshi Nakaguchi
- Department of Neurosurgery, Mitsui Memorial Hospital, 101-8643 Tokyo, Chiyoda City, Kanda Izumicho, 1, Japan
| | - Andreas Unterberg
- Department of Neurosurgery, Heidelberg University Hospital, Im Neuenheimer Feld 400, 69117 Heidelberg, Germany.
| | - Philip Dao Trong
- Department of Neurosurgery, Heidelberg University Hospital, Im Neuenheimer Feld 400, 69117 Heidelberg, Germany.
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Zhou J, Shi Q, Jiang L, Xie Y, Deng B, Zhan Y. Association study of the pneumatization degree of mastoid air cells and postoperative complications after microvascular decompression in hemifacial spasm. Acta Neurochir (Wien) 2022; 164:1543-1550. [PMID: 35190898 DOI: 10.1007/s00701-022-05155-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2021] [Accepted: 02/10/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND This study aimed to analyse the association between the degree of pneumatization of mastoid air cells (MACs) and postoperative complications after microvascular decompression in hemifacial spasm. METHODS We retrospectively reviewed 308 patients with hemifacial spasm who underwent surgery at our institute between January 2017 and March 2021. The degree of pneumatization of MACs was classified into four grades (grades 1, 2, 3, and 4) according to method of Han et al. The clinical data of the four grades were analysed and statistically examined. RESULTS There were no statistically significant differences between the four grades in terms of the operative time, intraoperative blood loss, and postoperative hospital stay (all, P > 0.05). The incidence of hearing loss was higher in grade 4 MACs (26.56%) than in grades 1 and 2 MACs (5.41% and 2.89%, respectively; P < 0.05). The incidence of facial paralysis was higher in grade 4 MACs (28.13%) than in grades 1 and 2 MACs (5.41% and 9.18%, respectively; P < 0.001). The incidence of intracranial infection was higher in grade 3 MACs (17.65%) than in grade 2 MACs (3.89%) (P < 0.05). All four patients with cerebrospinal fluid leakage belonged to grade 4 MACs. The incidence of cerebrospinal fluid leakage was higher in grade 4 MACs (5.13%) than in grade 2 MACs (P < 0.05). CONCLUSIONS This study found that the degree of pneumatization of MACs was closely related to the postoperative complications after MVD surgeries. Well-pneumatized MACs increase the risk of cerebrospinal fluid leakage and intracranial infection. However, insufficient exposure increases the risk of facial paralysis and hearing loss. For patients with well-pneumatized MACs, sufficient surgical exposure is the top priority when locating the bone hole. For those who may have a latent MAC opening, preventive occlusion should be considered.
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Affiliation(s)
- Jianxin Zhou
- Department of Neurosurgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, China
| | - Quanhong Shi
- Department of Neurosurgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, China
| | - Li Jiang
- Department of Neurosurgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, China
| | - Yanfeng Xie
- Department of Neurosurgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, China
| | - Bo Deng
- Department of Neurosurgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, China
| | - Yan Zhan
- Department of Neurosurgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, China.
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Yoshida S, Seki S, Sugiyama T, Kikuchi S, Yoshida N, Iino Y. Comparative study on adhesive otitis media and pars tensa cholesteatoma in children. Auris Nasus Larynx 2022; 49:790-796. [PMID: 35248415 DOI: 10.1016/j.anl.2022.02.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Revised: 01/19/2022] [Accepted: 02/13/2022] [Indexed: 11/18/2022]
Abstract
OBJECTIVE Recurrent otitis media and persistent otitis media with effusion in early childhood may cause an atelectatic eardrum and adhesive otitis media, which sometimes progress to pars tensa cholesteatoma. When and how children with adhesive otitis media should be operated on remain controversial. Therefore, this study aimed to analyze the clinical characteristics of children with adhesive otitis media and pars tensa cholesteatoma, and to determine the risk factors of progression to cholesteatoma. METHODS Seventeen ears of 15 children with adhesive otitis media (adhesive group) and 14 ears of 13 children with pars tensa cholesteatoma (tensa cholesteatoma group) who underwent tympanoplasty were included in this study. We analyzed the following clinical characteristics of children in both groups: medical and life history, associated diseases, sites of the adhesion, and development and aeration of mastoid air cells as shown by temporal bone computed tomography. RESULTS Most of the children in both groups had a history of recurrent otitis media and/or persistent otitis media with effusion. They showed a male predominance and a frequent association of allergic rhinitis. The number of ears showing undeveloped mastoid air cells in the tensa cholesteatoma group was significantly larger than that in the adhesive otitis media group (P=0.0068). A lack of aeration of the middle ear, including the eustachian tube, was more frequently found in ears with pars tensa cholesteatoma than in ears with adhesive otitis media (P=0.0012). Using multivariate logistic regression, the presence of otorrhea (odds ratio [OR], 14.847; 95% confidence interval [CI], 0.834-264.184), total adhesion (OR, 28.550; 95% CI, 0.962-847.508), and undeveloped mastoid air cells (OR, 19.357; 95% CI, 1.022-366.589) were related to pars tensa cholesteatoma. CONCLUSION Children with adhesive otitis media should be carefully followed up in the outpatient setting. Ears with poor mastoid development may develop pars tensa cholesteatoma. Additionally, ears with middle ear effusion, total adhesion, and the presence of otorrhea tend to be at risk of pars tensa cholesteatoma. Tympanoplasty or tympanostomy tube insertion should be considered for children with adhesive otitis media who have these risk factors to prevent progression to pars tensa cholesteatoma.
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Affiliation(s)
- Saeko Yoshida
- Department of Otolaryngology / Deafness and Middle Ear Surgicenter, Tokyo Kita Medical Center, 4-17-56, Akabanedai, Kita-ku, Tokyo 115-0053, Japan.
| | - Saori Seki
- Department of Otolaryngology / Deafness and Middle Ear Surgicenter, Tokyo Kita Medical Center, 4-17-56, Akabanedai, Kita-ku, Tokyo 115-0053, Japan
| | - Tomonori Sugiyama
- Department of Otolaryngology / Deafness and Middle Ear Surgicenter, Tokyo Kita Medical Center, 4-17-56, Akabanedai, Kita-ku, Tokyo 115-0053, Japan
| | - Saori Kikuchi
- Department of Otolaryngology / Deafness and Middle Ear Surgicenter, Tokyo Kita Medical Center, 4-17-56, Akabanedai, Kita-ku, Tokyo 115-0053, Japan
| | - Naohiro Yoshida
- Department of Otolaryngology Head and Neck Surgery, Jichi Medical University Saitama Medical Center, 1-847, Amanuma-cho, Omiya 330-0834, Japan
| | - Yukiko Iino
- Department of Otolaryngology / Deafness and Middle Ear Surgicenter, Tokyo Kita Medical Center, 4-17-56, Akabanedai, Kita-ku, Tokyo 115-0053, Japan; Department of Otolaryngology Head and Neck Surgery, Jichi Medical University Saitama Medical Center, 1-847, Amanuma-cho, Omiya 330-0834, Japan
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Bhatt AA, Lundy LB, Middlebrooks EH, Vibhute P, Gupta V, Rhyner PA. Superior Semicircular Canal Dehiscence : Covering Defects in Understanding from Clinical to Radiologic Evaluation. Clin Neuroradiol 2021; 31:933-941. [PMID: 34097081 DOI: 10.1007/s00062-021-01037-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Accepted: 05/06/2021] [Indexed: 11/29/2022]
Abstract
Superior semicircular canal dehiscence alters the normal fluid mechanics of the vestibulocochlear system and can be a debilitating condition. This article reviews the current understanding of the bony labyrinthine defect, including symptoms, etiology, surgical approach, as well as preoperative and postoperative imaging pearls.
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Affiliation(s)
- Alok A Bhatt
- Department of Radiology, Mayo Clinic, 4500 San Pablo Rd S, 32224, Jacksonville, FL, USA.
| | - Larry B Lundy
- Department of Otolaryngology, Mayo Clinic, 4500 San Pablo Rd S, 32224, Jacksonville, FL, USA
| | - Erik H Middlebrooks
- Department of Radiology, Mayo Clinic, 4500 San Pablo Rd S, 32224, Jacksonville, FL, USA
| | - Prasanna Vibhute
- Department of Radiology, Mayo Clinic, 4500 San Pablo Rd S, 32224, Jacksonville, FL, USA
| | - Vivek Gupta
- Department of Radiology, Mayo Clinic, 4500 San Pablo Rd S, 32224, Jacksonville, FL, USA
| | - Patricia A Rhyner
- Department of Radiology, Mayo Clinic, 4500 San Pablo Rd S, 32224, Jacksonville, FL, USA
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Singh S, Rettiganti MR, Qin C, Kuruva M, Hegde SV. Incidental mastoid opacification in children on MRI. Pediatr Radiol 2016; 46:704-8. [PMID: 26914938 DOI: 10.1007/s00247-016-3545-7] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2015] [Revised: 12/06/2015] [Accepted: 01/11/2016] [Indexed: 12/21/2022]
Abstract
BACKGROUND The opacification the mastoid cavity is frequently reported by radiologists on cross-sectional imaging done for non-otological indications. It is well known that presence of fluid the mastoid does not amount to mastoiditis. This study seeks to provide an evidence-based confirmation of this known finding. OBJECTIVE The purpose of our study was to determine the prevalence of mastoid opacification in children undergoing outpatient brain MRI examination. MATERIALS AND METHODS Our study included 515 outpatient children who had brain MRI for indications other than mastoiditis or otitis media from January 2014 to March 2014. Children with history of skull base trauma or radiation were excluded. The age range was 15 days to 18 years. The overall prevalence of mastoid opacification was determined using one sample proportion and exact 95% Clopper-Pearson confidence intervals. The prevalence of mastoid opacification was analyzed based on gender, age and presenting symptoms using chi-square test of association. RESULTS One hundred ten children (21.4%) had mastoid opacification. Younger patients tended to have higher opacification rates with the prevalence in children younger than 1 year of age and between 1 and 2 years of age as high as 41.7% (20/48) and 47.5% (38/80), respectively. CONCLUSION The diagnosis of mastoiditis in children should not be based upon a radiologist's report of finding fluid or mucosal thickening in the mastoid air cells as incidental opacification the mastoid is seen frequently.
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Affiliation(s)
- Sumit Singh
- Pediatric Radiology, University of Arkansas for Medical Sciences, 4301 W. Markham St., Little Rock, AR, 72205, USA.
| | - Mallikarjuna Rao Rettiganti
- Biostatistics Program, Department of Pediatrics, University of Arkansas for Medical Sciences and Arkansas Children's Hospital Research Institute, Little Rock, AR, USA
| | - Curtis Qin
- Radiology, Georgetown University Hospital, 3800 Reservoir Rd NW, Washington, DC, 20007, USA
| | - Manohar Kuruva
- Pediatric Radiology, University of Arkansas for Medical Sciences, 4301 W. Markham St., Little Rock, AR, 72205, USA
| | - Shilpa V Hegde
- Section of Neuroradiology, University of Pittsburgh Medical Centre, Pittsburgh, PA, USA
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