Arachnoid granulations of the posterior temporal bone wall: report of two cases

Arachnoid granulations play a role in CSF drainage. They are primarily located adjacent to cerebral venous sinuses. They may arise on a bony surface causing progressive bony erosion. We report two cases of arachnoid granulations eroding the posterior wall of the temporal bone. The aim of this paper was to illustrate the clinical presentation, and the imaging findings of arachnoid granulation of the posterior wall of the temporal bone. They remain asymptomatic in most cases, but they might cause a communication between the subarachnoid space and mastoid air cells, increasing the risk of bacterial meningitis, subdural empyema, and other intracranial infections. Differential diagnoses are also described, including endolymphatic sac tumours.     

Facial nerve management in temporal bone hemangiomas.

Eight patients with intratemporal hemangiomas involving the facial nerve are reported to present their symptoms, pathology, surgical management, and results. These unusual tumors have a predilection to involve the facial nerve, usually at the geniculate ganglion, internal auditory canal, or middle ear. Patients presented with facial palsy that was sudden, gradual in onset, recurrent, or associated with hemifacial spasm. Symptoms often progressed for years before the diagnosis was made. In two cases the tumor caused bony remodeling with an expansile honeycombed appearance, but no neoplastic production of bone. The facial nerve was comprised either by tumor compression or nerve invasion, as seen in two of our patients. Complete removal of the tumor and rehabilitation of the facial nerve function was attained in each case. Because of the destructive nature of these benign tumors, intratemporal facial nerve grafting was required in five of the eight cases. Results of facial nerve repair were good except in cases of long-standing facial dysfunction.     

Non-communicating arachnoid cyst of the temporal bone presenting as facial nerve paralysis in an infant.

Non-communicating arachnoid cyst of the lateral temporal bone is a rare condition. We present a case of a non-communicating arachnoid cyst of the temporal bone in an infant who presented with a lower motor neuron facial nerve paralysis. The patient was treated by surgical excision of the cyst.     

Squamous cell carcinoma of the temporal bone: results and management.

OBJECTIVE: Evaluation of the management and survival of patients treated for temporal bone squamous cell carcinoma. STUDY DESIGN: A retrospective analysis. SETTING: Tertiary care, academic referral center. PATIENTS: Twenty-eight patients underwent primary treatment for squamous cell carcinoma of the temporal bone. INTERVENTIONS: The patients were staged using the modified Pittsburgh staging system. Patients underwent a local resection, lateral temporal bone resection, or a subtotal lateral temporal bone resection usually followed by radiotherapy. MAIN OUTCOME MEASURE: The survival rate of patients grouped by tumor size was calculated. RESULTS: Staging revealed 12 pT1, 2 pT2, 4 pT3, and 10 pT4 tumors. The mean follow-up was 34 months (2-132 mo). The Kaplan-Meier survival curves showed survival rates at 5 years of 83 and 25% for the stages pT1 and pT4, respectively. The pooled survival curves showed survival rates at 5 years of 85 and 46% for the stages pT1p/T2 and pT3/pT4, respectively. CONCLUSION: Long-term prognosis of the carcinoma of the external auditory canal mainly depends on the stage and primary treatment. Surgery may consist of a lateral temporal bone or subtotal temporal bone resection; in T3 and T4 tumors, resection may be combined with a superficial parotidectomy. If disease is diagnosed in the neck or parotid, then a neck dissection and total parotidectomy may also be performed. Additional radiotherapy should be provided in incompletely resected T1 and all T2 and T3 tumors and part of the T4 tumors. T4 tumors may be treated according to their subclassification based on the anatomic extension.     

Combined petrosal approaches in the management of temporal bone meningiomas.

OBJECTIVES: To evaluate the indications and outcomes of the combined petrosal approaches in the surgical management of temporal bone meningiomas. STUDY DESIGN: Retrospective chart review. SETTING: University teaching hospital. PATIENTS: Adults with temporal bone meningiomas. INTERVENTION(S): Meningioma removal using a combined petrosal approach. MAIN OUTCOME MEASURE(S): Cranial nerve outcomes, complications, completeness of resection, and recurrence rates. RESULTS: Forty-nine patients underwent surgical excision of a temporal bone meningioma between 1996 and 2004 at our institution. Nineteen of these patients required a combined petrosal approach for excision. The most common presenting complaints were balance disturbance, 11 (58%); hearing loss, 10 (53%); headache, 10 (53%); and tinnitus, 9 (47%). The most common tumor origin was of the petrous ridge (14; 74%). Average tumor size was 3.1 cm. Complete resection was possible in 17 (89%) patients. Upper cranial nerve (III-VI) function was improved in two (11%) patients and worsened in three (16%) patients. Lower cranial nerve (IX-XII) function improved in one (5%) patient and was worsened in one (5%) patient. Postoperative facial nerve function was Grades I to II in 16 (84%) patients and Grades III to IV in 1 (5%) patient at last follow-up. Hearing data were available in 14 patients. Of those patients, 11 (85%) had serviceable hearing after surgery. The most common surgical complication was a cerebrospinal fluid leak, with three (16%) incidences. There were no reported incidents of stroke, death, or meningitis in the cohort. CONCLUSION: The use of the combined petrosal approach for temporal bone meningioma resection results in favorable outcomes for the patient. The incidence of complications is acceptably low, and cure rates are high.     

Chondrosarcomas of the temporal bone: presentation and management

Chondrosarcomas (CSA) of the temporal bone are rare primary malignant tumours that are slow growing, but locally aggressive. The management of CSAs involving the temporal bone is challenging and necessitates a multidisciplinary approach in a tertiary referral unit well practised in skull base surgery. Their management with particular reference to modes of presentation and treatment strategies has been reviewed here.     

儿童颞骨骨折临床特点和治疗策略

目的 探讨儿童颞骨骨折的临床特点及治疗策略.方法 回顾性分析2014年7月～2021年7月首都医科大学附属北京儿童医院确诊的477例18岁以下颞骨骨折患儿的临床资料,包括患儿性别、年龄、受伤原因、影像学、面神经及听力学评估、并发症、治疗及预后.结果 477例颞骨骨折患儿中男358例、女119例,男女比例为3∶1,年龄范...     

Pediatric temporal bone fractures.

Twenty-seven temporal bone fractures in 25 pediatric patients were evaluated over a 6-year period. The diagnosis was confirmed with otoscopy and high-resolution computed tomography scans (HRCT). Three-dimensional reconstruction of high-resolution computed tomography scans were used to aid in the diagnosis. The most common fracture was an oblique fracture which is oriented in an axial or horizontal plane with the temporal bone. Facial nerve paralysis was found in 6 of our patients, which is less than the expected incidence when compared to adults. Hearing loss was found in 24 patients, the most common of which was conductive hearing loss, which had a higher incidence than expected when compared with adults.     

Evaluation of a cement incus replacement prosthesis in a temporal bone model.

In reconstruction of the ossicular chain for a damaged incus, it is important that the incus replacement prosthesis (IRP) length is ideal in order to provide optimal tension between the tympanic membrane or malleus and stapes head to achieve the best post-operative hearing result. Even though the length of commercially available IRPs can be adjusted, it still may be difficult to achieve clinically. We describe experiments in a human temporal bone model using dental cement as an IRP after removal of the incus. This cement IRP (CIRP) hardens in situ and becomes the length of the gap to be spanned so that tension should be ideal. Two different CIRPs were studied; one was a conventional rod-type CIRP connecting either the umbo or mid-malleus handle to the stapes head. The second was a Y-shaped CIRP (Y-CIRP), connecting two sites on the malleus to the stapes head. The wide Y-CIRP connected the malleus head and umbo to the stapes head, while the narrow Y-CIRP connected the malleus neck and mid-handle to the stapes head. The acoustic performance of these experimental CIRPs was studied using a laser Doppler vibrometer system in 12 fresh human temporal bones. The CIRP demonstrated better acoustic performance than conventional IRPs studied previously in the same model. While all the CIRPs showed similar function below 2.0 kHz, the narrow Y-CIRP appeared best above 3.0 kHz. A prosthesis of this type may have an acoustic advantage over conventional IRPs.     

Cerebrospinal fluid leaks of temporal bone origin: etiology and management

BACKGROUND: Cerebrospinal fluid (CSF) leaks of the temporal bone region require surgical treatment as they pose life-threatening risks such as meningitis. AIM: The aim of the study was to determine the surgical outcome depending on different operation techniques and grafts. METHOD: We performed a retrospective review of 28 cases of CSF leaks, operated in our department from 1983 to 2002. After a mean follow-up of 8 years, patients were interviewed concerning otorrhea or rhinorrhea and meningitis. In this context, our management of CSF leaks is presented. RESULTS: The CSF leak had arisen spontaneously (n = 3), traumatically (n = 6) or postoperatively (n = 19). The surgical CSF leak repairs were performed via a transmastoid (n = 13), a middle fossa (n = 11) or a combined (n = 4) approach. Surgical outcome was independent on the used graft. CSF leak could be sealed in 25 of 28 cases. Only 3 patients suffered from recurrences. Meningitis or other complications did not occur. CONCLUSIONS: Comparing different techniques and grafts, there were no differences in the surgical outcome.     

Neoplasms of the temporal bone.

A series of 209 patients with chemodectomas and malignant neoplasms of the external auditory canal and middle ear seen during a 20-year period at the Mayo Clinic was reviewed. Ninety-nine patients had chemodectomas, and 110 had malignant lesions; 57 of the 110 patients with malignancies had squamous cell carcinoma. The study revealed that patients with chemodectomas had a normal expected length of survival, whereas patients with malignant lesions (especially those with squamous cell carcinomas and embryonal rhabdomyosarcomas) did poorly.     

Osteoradionecrosis of the temporal bone.

Six cases of osteoradionecrosis of the temporal bone are described. Persistent symptoms of otitis externa refractory to local treatment measures should alert the physician to the possibility of underlying osteoradionecrosis. Treatment of superficial parotidectomy and partial temporal bone resection with preservation of the facial nerve is indicated if local aggressive conservative measures fail to control the disease. Benign mixed tumors of the parotid gland should be treated surgically with avoidance of radiotherapy.