2025 Poster Presentations
P285: SUBTOTAL PETROSECTOMY AND EUSTACHIAN TUBE OBLITERATION FOR LIFE-THREATENING PNEUMOCEPHALUS AND CEREBROSPINAL FLUID LEAK
Hailey Mattheisen, MS; Abigail Peterson, BS; Nathan Zwagerman, MD; Michael Harris, MD; Stephanie Cheok, MD; Medical College of Wisconsin
Introduction: Spontaneous pneumocephalus is a rare, potentially serious condition often secondary to a cerebrospinal fluid (CSF) leak, where the egress of CSF causes aspiration of air through a bony and dural defect. Locating the bony defect through imaging is crucial to focus surgical intervention. In this case report, we present a patient with progressive spontaneous pneumocephalus without identifiable CSF leak and the treatment strategy.
Objective: The purpose of this study is to illustrate a case in which a patient presented with life-threatening pneumocephalus from a lateral skull base defect with no identifiable CSF leak. We discuss an alternative surgery to the traditional middle cranial fossa (MCF) approach for repair.
Methods: We performed an IRB-approved retrospective review of a patient treated at our institution.
Results: The patient was 76-year-old female presenting with spontaneous
pneumocephalus without overt evidence of CSF leak. Imaging showed dehiscence along the left petrous apex, but no fluid within the air cells. She began to rapidly decline and show worsening pneumocephalus on imaging (Figures 1A-D and 2). Given the urgent need for a definitive repair, and the high risk of the conventional option (MCF approach and petrosectomy with exposed petrous carotid), we decided to perform the less invasive approach via a subtotal petrosectomy and obliteration of the eustachian tube and external auditory canal (EAM). There were no postoperative complications, and the surgery was successful in resolving her pneumocephalus (Figure 1E-F).
Conclusion: In cases where there is clinical suspicion of a temporal CSF leak into the middle ear and Eustachian tube, obliteration of the Eustachian tube and closure of the EAM is a feasible alternative to a more conventional MCF approach. In our case, the less invasive approach resulted in definitive repair of the CSF leak.
Figure 1.
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Figure. 2