Sport Injuries of the Ear and Temporal Bone.

In cases of head trauma, the ear should be evaluated in all of its components. A good understanding of otologic and skull base anatomy enables a thorough trauma assessment of this complex anatomic region. Auricular laceration, abrasion, avulsion, hematoma, frostbite, otitis externa, exostosis, tympanic membrane perforation, ossicular discontinuity, perilymphatic fistula, labyrinthine concussion, temporal bone fracture, facial nerve paresis, and sensorineural hearing loss are a few of the more common otologic injuries seen in active patients. Prevention of otologic trauma by wearing protective equipment during activity is the best way of maintaining the long-term health of the ear and audiovestibular function.

Tenosynovial giant cell tumors of the temporomandibular joint and lateral skull base: Review of 11 cases.

OBJECTIVES: To elucidate the clinical behavior, treatment, and outcomes of tenosynovial giant cell tumors (TGCT) involving the temporomandibular joint (TMJ) and adjacent temporal bone. STUDY DESIGN: Retrospective case series with histopathologic review. METHODS: A retrospective chart review was performed identifying and collecting data from all cases of TGCT involving the TMJ and adjacent temporal bone that were treated at the authors' center between January 1960 and December 2015. RESULTS: Eleven histopathologically confirmed cases met inclusion criteria. The median age at diagnosis was 49 years, eight patients were men, and the median follow-up was 116 months. Computed tomographic (CT) imaging revealed a lytic expansile mass centered on the TMJ. Magnetic resonance imaging (MRI) most commonly exhibited hypointense signal on precontrast T1- and T2-weighted sequences and variable postcontrast enhancement. The median delay in diagnosis was 24 months, and the most common presenting symptoms were hearing loss and pain. All patients underwent surgical resection, eight receiving gross total removal, one receiving near total removal, and two patients from early in the series receiving subtotal resection with neoadjuvant or adjuvant radiation. Histopathological review of surgical specimens revealed chondroid metaplasia in seven tumors. Eight of nine cases receiving gross total or near total resection have no evidence of recurrence to date. CONCLUSIONS: TGCT of the TMJ and temporal bone are rare and locally aggressive tumors that commonly present with nonspecific symptoms. A careful review of CT and MRI followed by early biopsy is critical in establishing an accurate diagnosis and facilitating appropriate treatment. TGCT of the TMJ more commonly contain chondroid metaplasia when compared to TGCT at other anatomic locations. Gross total resection is achievable in most cases and offers long-term cure. Radiation may be considered for recurrent disease or adjuvant therapy following subtotal resection. LEVEL OF EVIDENCE: 4. Laryngoscope, 127:2340-2346, 2017.

Cholesterol Granuloma Development following Temporal Bone Surgery.

OBJECTIVE: To describe the clinical presentation and management of patients with cholesterol granulomas (CGs) that develop following temporal bone surgery. STUDY DESIGN: Case series with chart review. SETTING: Two independent tertiary academic referral centers. SUBJECTS AND METHODS: A multicenter retrospective review was performed to identify all patients between 2001 and 2014 who were diagnosed with a CG that developed following temporal bone surgery. Patients with a history of idiopathic petrous apex CGs were excluded, as were those with <6 months of follow-up after diagnosis. Demographic and clinical data were recorded at presentation, and the main outcome measure was symptom evolution over time. RESULTS: A total of 20 patients met inclusion criteria (median age, 55.0 years; 70.0% female), and their cases were analyzed. Diagnosis was made, on average, 149.5 months (median, 94.5; range, 13.0-480.0) following a temporal bone operation, which was for chronic ear disease in 75.0% of cases. The most common presenting symptoms were otalgia (55.0%) and otorrhea (40.0%). In patients initially managed with observation, 71.4% required no surgical intervention through a mean of 56.8 months (median, 30; range, 12.0-178.0) of follow-up. For those who initially underwent surgical excision, durable symptom relief was achieved in 66.7% of cases. CONCLUSION: Postoperative CG formation in the temporal bone is a rare occurrence that can be encountered years following surgery. The present study suggests that conservative management can be appropriate for many cases in which patients are relatively asymptomatic.

The Natural History and Management of Petrous Apex Cholesterol Granulomas.

OBJECTIVE: To evaluate the clinical and radiographic characteristics of cholesterol granulomas of the petrous apex, as well as the outcomes of operative and conservative management. STUDY DESIGN: Retrospective chart review. SETTING: Two independent tertiary academic referral centers. PATIENTS: Adult and pediatric patients with cholesterol granulomas of the petrous apex were identified from the experience of two separate centers. Patients were included after radiographic diagnosis and clinical evaluation. All patients with less than 6 months of follow-up and those with iatrogenic postoperative cholesterol granulomas were excluded. INTERVENTION: Demographic information, presenting symptoms, imaging characteristics, treatment strategies, and outcomes were recorded. MAIN OUTCOME MEASURES: Patients were evaluated on the basis of symptom and radiographic evolution during time, with or without operative intervention. RESULTS: Ninety petrous apex cholesterol granulomas were analyzed (57.8% females, 55.6% right-sided). The average age at presentation was 43.1 years (median 42.0, range 8.0-77.0 years). The most common presenting symptom was headache (56.7%), and the average lesion size in the greatest dimension was 2.1 cm (median 1.7, range 0.7-5.0 cm). During a mean follow-up of 46.0 months, no cases of spontaneous rupture or carotid injury occurred. Twenty-three patients (25.6%) ultimately underwent surgical management, most commonly for intractable headache, and only 47.8% of these patients experienced durable symptom improvement by their last postoperative follow-up. CONCLUSION: Many cholesterol granulomas of the petrous apex remain stable during time and can be safely managed with primary observation. Surgery should be reserved for lesions that are causing, or threatening, neurologic dysfunction because of mass effect or erosion of critical structures such as the otic capsule. Cranial neuropathy associated with cholesterol granuloma may improve after operative management; however, symptoms such as headache and dizziness are less likely to benefit from surgery. As a general guideline, in the presence of a radiologically stable cholesterol granuloma in the petrous apex, alternative etiologies for headache and dizziness should be considered and treated before offering surgical intervention.

Incidentally Discovered Unruptured AICA Aneurysm After Radiosurgery for Vestibular Schwannoma: A Case Report and Review of the Literature.

OBJECTIVE: This is a case report and review of the literature of aneurysm formation after stereotactic radiosurgery (SRS) in the posterior fossa. Cerebral aneurysm formation is not a commonly recognized complication of SRS. We present the first case of an unruptured anteroinferior cerebellar artery aneurysm incidentally found at surgery in a patient with trigeminal neuralgia secondary to a vestibular schwannoma (VS) first treated with Gamma Knife radiosurgery. Other cases of posterior fossa aneurysms associated with SRS and the pathogenesis of vascular injury by radiation are discussed. PATIENT: A 57-year-old woman with medically intractable severe trigeminal neuralgia secondary to a 1.4-cm VS treated with SRS 10 years previously at an outside institution. INTERVENTION: The patient underwent a left retrosigmoid craniotomy for tumor debulking. MAIN OUTCOME AND RESULTS: During resection, two small aneurysms on the tumor's ventral side arising from the main trunk of the anteroinferior cerebellar artery were encountered and treated with direct clip ligation, sparing the parent vessel. The patient did well after surgery and was discharged home on Hospital Day 4 at her neurologic baseline, with normal facial nerve function and without trigeminal pain. CONCLUSION: Although aneurysms associated with posterior fossa SRS are rare, there are at least seven reports, including the current case, in the past decade. Because the relationship between radiation and aneurysm formation is unproven and controversial, further study, especially examining long-term effects, is needed. Given the overall rarity and uncertain association between SRS and aneurysm formation, we do not recommend routine aneurysm surveillance screening in patients undergoing Gamma Knife radiosurgery for VS. Surgeons should be aware of the rare possibility of encountering an aneurysm during surgical exploration in patients with VS who fail SRS.