Alicandri-Ciufelli Matteo, Serafini Edoardo, Rosini Maria, Liberale Carlotta, De Cecco Francesca, Loos Elke, Garofalo Paolo, Cardobi Nicolò, Rubini Alessia, Marchioni Daniele
Department of Otolaryngology Head and Neck Surgery, University Hospital of Modena, Modena, Italy.
Unit of Otorhinolaryngology, Head & Neck Department, University of Verona, Verona, Italy.
Otol Neurotol. 2025 Jun 1;46(5):e176-e182. doi: 10.1097/MAO.0000000000004483. Epub 2025 Feb 25.
Transpromontorial approaches require obliteration of the surgical cavity and the eustachian tube, along with cul-de-sac external auditory canal closure, without obliteration of the mastoid air cells. This study aims to evaluate the clinical and radiological implications of tympanic cavity obliteration when the mastoid air cell system is preserved.
Retrospective observational study.
Tertiary referral center.
Thirty-one adult patients with unilateral vestibular schwannoma.
Patients underwent resection of a vestibular schwannoma through either an exclusive endoscopic transcanal transpromontorial approach (endoTTA) or an expanded transcanal transpromontorial approach (expTTA).
Postoperative radiologic mastoid and surgical cavity content and clinical outcomes.
Thirty-one patients met the inclusion criteria. The mean radiological follow-up was 54 months. Regarding mastoid content, air was present in 13 patients (42%) and trapped fluid in 18 patients (58%). Surgical cavity content revealed air in 14 patients (45%), trapped fluid in 8 patients (26%), total fat obliteration in 5 patients (16%), and partial fat obliteration in 4 patients (13%). No cases of mucocele, cholesterol granuloma, or iatrogenic cholesteatoma were observed. Three main radiological patterns were identified by combining mastoid and surgical cavity findings. EndoTTA was found to be significantly associated with postoperative radiological air content in the mastoid cavity ( p value = 0.013), while no association was found between the type of radiological pattern and the development of complications or symptoms at the last follow-up.
EndoTTA and expTTA are safe and effective procedures, with no increased risk of meningitis or CSF leak, even in cases where obliteration tissue is reabsorbed.
经鼓岬入路需要封闭手术腔和咽鼓管，同时封闭外耳道盲端，而不封闭乳突气房。本研究旨在评估保留乳突气房系统时鼓室封闭的临床和影像学意义。
回顾性观察研究。
三级转诊中心。
31例单侧前庭神经鞘瘤成年患者。
患者通过单纯内镜经耳道经鼓岬入路（endoTTA）或扩大经耳道经鼓岬入路（expTTA）切除前庭神经鞘瘤。
术后影像学乳突和手术腔内容物及临床结果。
31例患者符合纳入标准。影像学平均随访时间为54个月。关于乳突内容物，13例患者（42%）存在气体，18例患者（58%）存在潴留液。手术腔内容物显示，14例患者（45%）存在气体，8例患者（26%）存在潴留液，5例患者（16%）完全被脂肪填充，4例患者（13%）部分被脂肪填充。未观察到黏液囊肿、胆固醇肉芽肿或医源性胆脂瘤病例。通过结合乳突和手术腔检查结果确定了三种主要影像学模式。发现endoTTA与乳突腔术后影像学气体含量显著相关（p值=0.013），而在最后一次随访时，影像学模式类型与并发症或症状的发生之间未发现关联。
endoTTA和expTTA是安全有效的手术方法，即使在封闭组织被吸收的情况下，脑膜炎或脑脊液漏的风险也不会增加。
