99Tc m-DTPA SPECT/CT imaging in the diagnosis of cerebrospinal fluid leakage / 中华核医学与分子影像杂志

Objective:To investigate the diagnostic efficacy and clinical application value of 99Tc m-diethylene triamine pentaacetic acid (DTPA) SPECT/CT imaging in cerebrospinal fluid leakage (CSFL). Methods:A total of 23 patients (11 males, 12 females; age (44.2±15.1) years) who underwent endoscopic repair surgery for suspected CSFL in Shanghai Jiao Tong University Affiliated Sixth People′s Hospital between April 2018 and January 2020 were retrospectively reviewed. All patients performed 99Tc m-DTPA SPECT/CT imaging, paranasal sinus high resolution CT (HRCT) and MRI before surgery. The diagnostic efficacies of 3 imaging techniques were calculated according to the result of surgery regarded as the golden standard. χ2 test was used to compare the qualitative and localized diagnostic efficacies of 3 imaging techniques for CSFL. Results:Of 23 patients, 21 were finally confirmed with CSFL and 24 leak locations were identified according to the results of surgery; the other 2 patients had no obvious CSFL and no leak location was found during the operation. The sensitivity and accuracy of 99Tc m-DTPA SPECT/CT, MRI and HRCT for the diagnosis of CSFL were 100%(21/21) and 95.7%(22/23), 85.7%(18/21) and 82.6%(19/23), 76.2%(16/21) and 69.6%(16/23), respectively. The accuracy of 99Tc m-DTPA SPECT/CT, MRI and HRCT for the diagnosis of leak location was 79.2%(19/24), 50.0%(12/24) and 45.8%(11/24), respectively. There was no statistically significant difference of diagnostic efficacies for CSFL among 3 imaging techniques ( χ2 values: 0.451-3.453, all P>0.05). For leak location, the diagnostic efficacy of 99Tc m-DTPA SPECT/CT was significantly better than that of MRI and HRCT ( χ2 values: 4.463, 5.689, both P<0.05). Conclusion:99Tc m-DTPA SPECT/CT imaging shows an excellent diagnosis efficacy not only for CSFL but also for leak location, which is helpful for guiding surgery.

Analysis of the diagnosis and treatment of cerebrospinal fluid otorrhea / 临床耳鼻咽喉头颈外科杂志

Objective:To analyze the etiology and clinical symptoms and to investigate the therapeutic strategies of cerebrospinal fluid otorrhea. Method:A retrospective analysis of 37 cases of patients with cerebrospinal fluid otorrhea.The clinical symptoms, auxiliary examination, intraoperative findings, surgical methods and postoperative follow-up were analyzed. Result:In 37 cases, 35 patients underwent the plugging surgery once and cured, 1 patient with inner ear malformation underwent another operation and cured, 1 patient didn't have the operation. No cerebrospinal fluid leakage or meningitis recurrence was reported by the followed up from 1 months to 7 years after operation. Conclusion:Surgical repair is an effective method to treat the cerebrospinal fluid otorrhea. It is significant to take appropriate surgical approach to expose and to find the leak, according to the etiological factor and imaging examination.

CT and MRI diagnostic value of the congenital inner ear malformation incomplete partition type Ⅱdeformity combined with spontaneous CSF otorrhea / 实用放射学杂志

Objective To discuss the diagnostic value of high resolution computed tomography (HRCT)and MRI in the congenital inner ear malformation incomplete partition type Ⅱ deformity(Mondini deformity)combined with spontaneous cerebrospinal fluid (CSF)otorrhea.Methods The imaging data including the multiplanar reformation(MPR)images of HRCT,curved planar reforma-tion(CPR)images and MR hydrography images in three patients complicated with recurrent meningitis were retrospectively ana-lyzed.The anatomic changes of the inner ear and middle ear on the affected side were observed,the clinical and imaging features of this disease were summarized.Results One patient had bilateral incidence of the incompletely separated inner ear,combined with semicircular canal dysplasia and cochlear pipe dilation.Two patients had unilateral onset,one of them had concurrent facial nerve ca-nal dysplasia.Humble stapes floor and the defect of the bottom of the internal auditory canal were seen in all the three patients.Con-clusion HRCT with post-processing technology,and MRI have great significance in the diagnosis of the congenital inner ear malfor-mation incomplete partition type Ⅱ deformity (Mondini deformity)combined with spontaneous CSF otorrhea.

Selection of surgical options for temporal occipital epidural hematomas / 中华创伤杂志

Objective To investigate the choice of surgical procedures in the treatment of temporal occipital epidural hematomas.Methods From March 2006 to March 2011,176 cases with acute temporal occipital epidural hematomas were treated in our hospital.Their clinical data including preoperative Glasgow Coma Sale (GCS),pupil size,hematoma volume,cerebrospinal fluid leakage,time between injury and operation,cerebral midline shift on CT,and brain beat and brain swelling in the operation were retrospectively analyzed.Results There were significant differences in the choice of surgical treatment and prognosis of temporal occipital epidural hematoma according to the preoperative GCS score,pupillary changes,hematoma volume,length of time before surgery,shift of cerebral midline structures,and brain beat and brain swelling in the operation.Conclusion Appropriate surgical procedures selected according to their preoperative and intraoperative conditions is of significant importance for sound prognosis of the patients with acute temporal occipital epidural hematoma.

Cerebrospinal Fluid Otorrhea Caused by Arachnoid Granulation

Cerebrospinal fluid (CSF) leakage otorrhea may be congenital or can be caused by trauma, surgery, cholesteatoma, and tumors. Spontaneous CSF leakage through the middle ear without a secondary cause is a relatively rare disease. The pathophysiology of CSF otorrhea has not been clear yet. However, there are two theories of the pathophysiology of spontaneous CSF otorrhea have been studied in the medical field: one based on the congenital defect; the other about the arachnoid granulation which causes bone erosion. Herein, we examine and report a case of CSF otorrhea caused by arachnoid granulation. Literatures pertaining to the disorder will be reviewed and characteristics of the disorder also will be discussed.

Cerebrospinal Fluid Otorrhea Caused by Arachnoid Granulation

Cerebrospinal fluid (CSF) leakage otorrhea may be congenital or can be caused by trauma, surgery, cholesteatoma, and tumors. Spontaneous CSF leakage through the middle ear without a secondary cause is a relatively rare disease. The pathophysiology of CSF otorrhea has not been clear yet. However, there are two theories of the pathophysiology of spontaneous CSF otorrhea have been studied in the medical field: one based on the congenital defect; the other about the arachnoid granulation which causes bone erosion. Herein, we examine and report a case of CSF otorrhea caused by arachnoid granulation. Literatures pertaining to the disorder will be reviewed and characteristics of the disorder also will be discussed.

Cerebellar Hernia in a Patient with Chronic Otorrhea / 대한이비인후과학회지

Brain hernia into the middle ear cavity is quite a rare entity which is often caused by chronic otitis media with cholesteatoma and surgical complications. Other unusual factors such as extension of the intracranial meningioma, primary temporal bone meningioma and aberrant arachnoid granulation can also cause hernia of brain tissue. Brain hernia can be diagnosed through temporal bone computed tomography (TBCT) and brain magnetic resonance image (MRI), which show the location of bony defect and similar signal intensity between the herniated tissue and brain. We present a 50-year old female patient, who suffered from otorrhea 8 years ago; otorrhear disappeared 4 years ago and rhinorrhea 1 years ago. She had not have any history of chronic otitis media and otologic surgery. The herniated cerebellum was diagnosed through the TBCT and brain MRI. She was successfully cured after cerebellar reduction operation without any postoperative complications.

A Case of Profuse Cerebrospinal Fluid Otorrhea with Common Cavity Cochlea in Adult / 대한이비인후과학회지

Cerebrospinal fluid (CSF) otorrhea with inner ear anomaly and common cavity anomaly in adults is very rare, especially as a first symptom except hearing loss. Surgical intervention is the primary treatment for profuse CSF leaks by cochlear anomaly. It can be treated when CSF leaks are encountered after cochlear implant surgery and are controlled with temporalis muscle plugs, fascia and fibrin glue. We should advise patients with congenital inner ear anomaly about sudden cerebrospinal fluid leaks or recurrent meningitis. We report a case of cerebrospinal fluid otorrhea with common cavity cochlea in an adult with a review of literature.

CLINICAL STUDY OF TEMPORAL BONE FRACTURE AND ITS COMPLICATIONS / 解放军医学杂志

To explore the characteristics and treatment of temporal bone fractures and its complications, clinical data of 48 cases of temporal bone fracture admitted to our hospital from January 1989 to November 1999 were retrospectively analyzed. The results showed that in these 48 patients temporal bone fracture caused by traffic accidents accounted for 66 67%. Forty three cases survived (89 58%) and 5 died (10 41%). Middle inner ear or craniocerebral injury held 77 08% and hearing loss or tinitus held 48%; The incidences of CSF otorrhea and facioplegia were 36 7% and 3%, respectively for the longitudinal fracture, while for the transversal fracture they were 25% and 37 5%, respectively. Our conclusions are: (1) Traffic injury is the most dangerous factor of temporal bone fracture; (2) The dangerous complication is injury to cranium and brain, or multiple organs, resulting in death; (3) Middle inner ear injury is the commonest complication in temporal bone fracture; (4) CSF otorrhea is common in the longitudinal fracture and facioplegia is common in the transversal fracture.