The Gruppo Otologico, Italy
Title: Temporal bone meningo-encephalic-herniation: etiological categorization and surgical strategy
Clinical Fellow in Otology, Neurotology & Skull Base Surgery at The Gruppo Otologico, Piacenza, Italy under Prof. Mario Sanna guidance. ENT specialist at Hillel Yaffe Hospital, Affiliated to the Technion University in Haifa, Hadera, Israel. Residency of Otorhinolaryngology, Head and Neck Surgery Department, Hadassah Ein Karem Hospital, Jerusalem, Israel. During the period I wrote scientific work under the guidance of prof. Sohmer 'Acoustic activation in the presence of an immobilized stapes, oval window and round window' Residency of Otorhinolaryngology, Head and Neck Surgery Department at Sheba Hospital.During the period I accepted the Tel Hashomer Award of Honorable Resident. Internship at Beilinson Hospital, which included elective in Otorhinolaryngology both in Tel Hashomer, Meir and Beilinson
To study the clinical presentation, intraoperative findings and surgical management in Meningo-encephalic-herniation (MEH) based on the etiology. The inclusion criteria were intraoperatively verified MEH in patients with a minimum follow-up of 12 months which yielded 262 operated ears. The data were extracted regarding demographics, laterality, clinical presentation, past surgeries, contralateral-ear condition, intraoperative findings, complications, recurrences, revision-surgeries, audiometric-data and follow-up. The mean age at surgery was 49.7 years with the involvement of right-ear in 53.8% of cases. Lesions were categorized based on the etiology as chronic-otitis-media with/without cholesteatoma-MEH (COM/CHOL-MEH)-47.7%; iatrogenic-MEHs -20.9%; traumatic-MEHs -8% and spontaneous-MEHs-23.3%. At presentation, hearing loss (100% and 98.2%) and otorrhea (65.6% and 49.1%) were predominant in COM/CHOL-MEHs and iatrogenic-MEHs respectively. On the other hand, meningitis (23.9% and 14.3%) and cerebrospinal fluid-leak (52.4% and 42.8%) were more pronounced in spontaneous and traumatic MEHs, respectively. Surgical approaches included- 1) Transmastoid, 2) Middle-cranial-fossa-approach (MCFA), 3) Combined and 4) Middle-ear- obliteration (MEO) techniques. A total of 52.8% of COM/CHOL-MEHs and 49.1% of iatrogenic-MEHs underwent MEO. MCFA was predominantly used in spontaneous-MEHs (52.5%) and traumatic-MEHs (38.1%). The defect was mostly single (75.2%). Smaller, multiple, bilateral lesions were more common in spontaneous-MEHs with tegmen-tympani involvement (57.4%). Incorporating etiology into MEHs is a key-step which can be used as a guidance in choosing the right surgery. MEO is a part of armamentarium, and should be used whenever needed, if the objective is performing a definitive surgery.