TY - JOUR
T1 - Challenges in the Management of Symptomatic Fallopian Canal Meningoceles
T2 - A Multicenter Case Series and Literature Review
AU - Filip, Peter
AU - Chiang, Harry
AU - Goldberg, Allison
AU - Khorsandi, Azita S.
AU - Moonis, Gul
AU - Moody Antonio, Stephanie A.
AU - Wanna, George
AU - Cosetti, Maura
N1 - Publisher Copyright:
© Wolters Kluwer Health, Inc. All rights reserved.
PY - 2024/4/1
Y1 - 2024/4/1
N2 - Objective To describe the presentations, the diagnosis, our treatment approaches, and the outcomes for 11 patients with fallopian canal meningocele (FCM). Study Design: Multicenter Retrospective case series. Setting Tertiary referral centers. Patients Patients (N = 11) with radiographically or intraoperatively identified, symptomatic FCM. Interventions Surgical repair of cerebrospinal fluid (CSF) leak and meningocele versus observation. Main Outcome Measures Presentation (including symptoms, radiographic imaging, and comorbidities), management (including surgical approach, technique for packing, use of lumbar drain), clinical outcomes (control of CSF leak, meningitis, facial nerve function), and revision surgery. Results Patients presented with spontaneous CSF leak (n = 7), conductive (N = 11) and sensorineural hearing loss (n = 3), nonpositional intermittent vertigo (n = 3), headaches (n = 4), and recurrent meningitis (n = 1). Risk factors in our series included obesity (n = 4), Chiari 1 malformation (n = 1), and head trauma (n = 2). Noncontrast computed tomography of the temporal bone and magnetic resonance imaging were positive for FCM in 10 patients. Eight patients were managed surgically via a transmastoid approach (n = 4), combined transmastoid and middle fossa (N = 3), or middle fossa alone (n = 1); three were managed conservatively with observation. Postoperative complications included worsened facial nerve palsy (n = 1), recurrent meningitis (n = 1), and persistent CSF leak that necessitated revision (n = 1). Conclusions Facial nerve meningoceles are rare with variable presentation, often including CSF otorrhea. Management can be challenging and guided by symptomatology and comorbidities. Risk factors for FCM include obesity and head trauma, and Chiari 1 malformation may present with nonspecific otologic symptoms, in some cases, meningitis and facial palsy. Layered surgical repair leads to high rates of success; however, this may be complicated by worsening facial palsy.
AB - Objective To describe the presentations, the diagnosis, our treatment approaches, and the outcomes for 11 patients with fallopian canal meningocele (FCM). Study Design: Multicenter Retrospective case series. Setting Tertiary referral centers. Patients Patients (N = 11) with radiographically or intraoperatively identified, symptomatic FCM. Interventions Surgical repair of cerebrospinal fluid (CSF) leak and meningocele versus observation. Main Outcome Measures Presentation (including symptoms, radiographic imaging, and comorbidities), management (including surgical approach, technique for packing, use of lumbar drain), clinical outcomes (control of CSF leak, meningitis, facial nerve function), and revision surgery. Results Patients presented with spontaneous CSF leak (n = 7), conductive (N = 11) and sensorineural hearing loss (n = 3), nonpositional intermittent vertigo (n = 3), headaches (n = 4), and recurrent meningitis (n = 1). Risk factors in our series included obesity (n = 4), Chiari 1 malformation (n = 1), and head trauma (n = 2). Noncontrast computed tomography of the temporal bone and magnetic resonance imaging were positive for FCM in 10 patients. Eight patients were managed surgically via a transmastoid approach (n = 4), combined transmastoid and middle fossa (N = 3), or middle fossa alone (n = 1); three were managed conservatively with observation. Postoperative complications included worsened facial nerve palsy (n = 1), recurrent meningitis (n = 1), and persistent CSF leak that necessitated revision (n = 1). Conclusions Facial nerve meningoceles are rare with variable presentation, often including CSF otorrhea. Management can be challenging and guided by symptomatology and comorbidities. Risk factors for FCM include obesity and head trauma, and Chiari 1 malformation may present with nonspecific otologic symptoms, in some cases, meningitis and facial palsy. Layered surgical repair leads to high rates of success; however, this may be complicated by worsening facial palsy.
KW - Cerebrospinal fluid otorrhea
KW - Facial nerve
KW - Fallopian canal meningocele
UR - http://www.scopus.com/inward/record.url?scp=85187735417&partnerID=8YFLogxK
U2 - 10.1097/MAO.0000000000004155
DO - 10.1097/MAO.0000000000004155
M3 - Article
C2 - 38478412
AN - SCOPUS:85187735417
SN - 1531-7129
VL - 45
SP - 434
EP - 439
JO - Otology and Neurotology
JF - Otology and Neurotology
IS - 4
ER -