Treatment of Temporal Bone Fractures.

Treatment of Temporal Bone Fractures.

J Neurol Surg B Skull Base. 2016 Oct;77(5):419-429

Authors: Diaz RC, Cervenka B, Brodie HA

Abstract
Traumatic injury to the temporal bone can lead to significant morbidity or mortality and knowledge of the pertinent anatomy, pathophysiology of injury, and appropriate management strategies is critical for successful recovery and rehabilitation of such injured patients. Most temporal bone fractures are caused by motor vehicle accidents. Temporal bone fractures are best classified as either otic capsule sparing or otic capsule disrupting-type fractures, as such classification correlates well with risk of concomitant functional complications. The most common complications of temporal bone fractures are facial nerve injury, cerebrospinal fluid (CSF) leak, and hearing loss. Assessment of facial nerve function as soon as possible following injury greatly facilitates clinical decision making. Use of prophylactic antibiotics in the setting of CSF leak is controversial; however, following critical analysis and interpretation of the existing classic and contemporary literature, we believe its use is absolutely warranted.

PMID: 27648399 [PubMed - as supplied by publisher]

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Cochleovestibular nerve compression syndrome due to intrameatal Anterior Inferior Cerebellar Artery loop: synthesis of best evidence for clinical decisions.

Cochleovestibular nerve compression syndrome due to intrameatal Anterior Inferior Cerebellar Artery loop: synthesis of best evidence for clinical decisions.

World Neurosurg. 2016 Sep 16;

Authors: Esposito G, Messina R, Carai A, Colafati GS, Randi F, De Benedictis A, Cossu S, Fontanella MM, Marras CE

Abstract
INTRODUCTION: Intrameatal cochleovestibular neurovascular conflict is a rare condition with specific clinical and therapeutic implications. Although surgery is commonly indicated in other neurovascular conflicts, for this subset of patients there is little evidence to guide treatment decisions. Moving from a case description, we performed a review of the literature on this topic in order to systematically present the best available evidence to guide clinical decisions.
MATERIALS AND METHODS: We performed a literature review on reported cases of surgically treated intrameatal anterior inferior cerebellar artery (AICA) - cochleovestibular nerve (CVN) neurovascular conflict, analyzing preoperative clinical data, surgical techniques, and outcomes. We analyzed the levels of evidence using the King's college guidelines DISCUSSION: We found 35 studies of neurovascular compression of CVN by AICA for a total of 536 patients operated to resolve their neurovascular conflict. Only four of these studies describe intrameatal AICA neurovascular conflicts, for a total of 9 cases, including our own. Tinnitus was the most frequent symptom (9/9), followed by vertigo (2/9). Our case was the only one showing unilateral hearing loss. Surgery consisted in microsurgical mobilization of AICA loop performed through a retrosigmoid craniotomy. Tinnitus and vertigo resolved after surgery in all cases, whereas hearing loss did not improve after surgery.
CONCLUSION: Surgical treatment offers the best results for tinnitus and vertigo, but it seems to have no effect on hearing loss, not even at long term follow-up. Microvascular decompression should be proposed to intrameatal symptomatic patients before the onset of hearing loss.

PMID: 27647022 [PubMed - as supplied by publisher]

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