Evaluation of clinical predictors of postoperative outcomes in tegmen defect patients with and without concurrent superior semicircular canal dehiscence and cerebrospinal fluid leak

Tritan Plute; Hussam Abou-Al-Shaar; Norah Alarifi; Aneek Patel; Arka N Mallela; Khalil Baddour; Georgios A Zenonos; Andrew A McCall; Paul A Gardner

doi:10.1016/j.amjoto.2024.104317

Evaluation of clinical predictors of postoperative outcomes in tegmen defect patients with and without concurrent superior semicircular canal dehiscence and cerebrospinal fluid leak

Am J Otolaryngol. 2024 Apr 19;45(4):104317. doi: 10.1016/j.amjoto.2024.104317. Online ahead of print.

Authors

Tritan Plute¹, Hussam Abou-Al-Shaar², Norah Alarifi³, Aneek Patel², Arka N Mallela², Khalil Baddour⁴, Georgios A Zenonos², Andrew A McCall⁴, Paul A Gardner⁵

Affiliations

¹ University of Pittsburgh School of Medicine, Pittsburgh, PA, United States of America.
² Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, United States of America.
³ Department of Neurological Surgery, University of Manitoba, Winnipeg, MB, Canada.
⁴ Department of Otolaryngology, University of Pittsburgh Medical Center, Pittsburgh, PA, United States of America.
⁵ Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, United States of America. Electronic address: gardpa@upmc.edu.

PMID: 38729011
DOI: 10.1016/j.amjoto.2024.104317

Abstract

Objectives: Tegmen and superior semicircular canal defects have been well studied, yet the factors contributing to their onset and progression are widely debated. The clinical utility of intraoperative intracranial pressure measurements has yet to be tested. This report aims to use intraoperative opening pressure and concurrent superior semicircular canal dehiscence (SSCD) to analyze factors influencing disease course and clinical outcomes in patients with tegmen dehiscence.

Methods: A retrospective analysis of 61 patients who underwent tegmen defect repair was performed. Multiple variables of interest including body mass index (BMI), presence of SSCD, presence of dural venous sinus stenosis, opening pressure, and acetazolamide therapy use were recorded. The cohort was divided into those with or without concurrent SSCD and those presenting with or without cerebrospinal fluid (CSF) leak for analysis.

Results: A linear relationship between opening pressure and BMI (p = 0.009) was noted; however, intraoperative opening pressure was not associated with disease outcome. Concurrent SSCD was present in 25 % of patients, while 62 % presented with CSF leak. The concurrent SSCD group exhibited higher opening pressure, higher likelihood of having dural sinus stenosis, and higher likelihood of being discharged on acetazolamide. The CSF leak group had higher likelihood of obstructive sleep apnea and persistent symptoms.

Conclusions: In patients undergoing tegmen defect repair, concurrent SSCD suggests increased disease severity. The presence of preoperative CSF leak predicts persistent symptoms following repair. BMI is linearly correlated with intracranial pressure in these patients.

Keywords: Cerebrospinal fluid; Intracranial hypertension; Lumbar puncture; Middle Fossa craniotomy; Obesity; Superior semicircular canal dehiscence; Tegmen defect.