Classification of middle fossa floor dehiscence syndromes

Kunal Gupta, Hatem A. Sabry, Aclan Dogan, Nicholas D. Coppa, Sean McMenomey, Johnny B. Delashaw, Ahmed Raslan

Research output: Contribution to journalArticle

3 Citations (Scopus)

Abstract

OBJECT: Middle fossa floor dehiscence (MFFD) can present as multiple syndromes depending on dehiscence location, tissue herniation, and dural integrity. The authors propose a classification system for MFFD with the potential to guide clinical decision making.

METHODS: A retrospective analysis of the electronic medical records (years 1995-2012) of patients who had undergone temporal craniotomy for the surgical repair of an MFFD syndrome at a single institution was undertaken. Reviewed data included demographic, operative, presentation, and outcome details. Middle fossa floor dehiscence was classified as follows: Class A, bony dehiscence without herniation of the brain and/or meninges; Class B, herniation of the brain and/or meninges through the middle fossa floor without CSF leakage; Class C, dehiscence with CSF leakage without meningitis; or Class D, dehiscence with meningitis.

RESULTS: Fifty-one patients, 22 males and 29 females, were included in the analysis. The mean age was 48.7 ± 15.5 years, mean body mass index was 32.65 ± 6.86 kg/m(2), and mean symptom duration was 33 ± 42 months. Seven patients underwent repeat surgery for symptomatic recurrence; therefore, there were 58 surgical encounters. Repair included bony reconstruction with hydroxyapatite with or without resection of encephaloceles and/or repair of a dural defect. According to the MFFD classification system described, 15, 8, 27, and 8 cases were categorized as Class A, B, C, and D, respectively. The prevalence of hearing loss was 87%, 63%, and 70% in Classes A, B, and C, respectively. Vestibular symptoms were more prevalent in Class A. Seven patients reported persistent symptoms at the last follow-up. Transient complications were similar in each classification (13%-25%), and a single permanent complication related to anesthesia was observed. There were no mortalities or severe neurological morbidities in the series.

CONCLUSIONS: Middle fossa floor dehiscence has a spectrum of clinical presentations. A classification system may help to clarify the diagnosis and guide therapy. Surgery, the mainstay of treatment, is safe and well tolerated.

Original languageEnglish (US)
Pages (from-to)557-563
Number of pages7
JournalJournal of Neurosurgery
Volume122
Issue number3
DOIs
StatePublished - Mar 1 2015

Fingerprint

Meninges
Meningitis
Encephalocele
Electronic Health Records
Craniotomy
Brain
Durapatite
Reoperation
Hearing Loss
Body Mass Index
Anesthesia
Demography
Morbidity
Recurrence
Mortality
Therapeutics
Clinical Decision-Making

Keywords

  • BMI = body mass index
  • MFFD = middle fossa floor dehiscence
  • middle fossa floor dehiscence
  • OHSU = Oregon Health & Science University
  • surgical outcomes
  • surgical stratification
  • surgical technique
  • Tullio's phenomenon

ASJC Scopus subject areas

  • Medicine(all)

Cite this

Gupta, K., Sabry, H. A., Dogan, A., Coppa, N. D., McMenomey, S., Delashaw, J. B., & Raslan, A. (2015). Classification of middle fossa floor dehiscence syndromes. Journal of Neurosurgery, 122(3), 557-563. https://doi.org/10.3171/2014.11.JNS132798

Classification of middle fossa floor dehiscence syndromes. / Gupta, Kunal; Sabry, Hatem A.; Dogan, Aclan; Coppa, Nicholas D.; McMenomey, Sean; Delashaw, Johnny B.; Raslan, Ahmed.

In: Journal of Neurosurgery, Vol. 122, No. 3, 01.03.2015, p. 557-563.

Research output: Contribution to journalArticle

Gupta, K, Sabry, HA, Dogan, A, Coppa, ND, McMenomey, S, Delashaw, JB & Raslan, A 2015, 'Classification of middle fossa floor dehiscence syndromes', Journal of Neurosurgery, vol. 122, no. 3, pp. 557-563. https://doi.org/10.3171/2014.11.JNS132798
Gupta K, Sabry HA, Dogan A, Coppa ND, McMenomey S, Delashaw JB et al. Classification of middle fossa floor dehiscence syndromes. Journal of Neurosurgery. 2015 Mar 1;122(3):557-563. https://doi.org/10.3171/2014.11.JNS132798
Gupta, Kunal ; Sabry, Hatem A. ; Dogan, Aclan ; Coppa, Nicholas D. ; McMenomey, Sean ; Delashaw, Johnny B. ; Raslan, Ahmed. / Classification of middle fossa floor dehiscence syndromes. In: Journal of Neurosurgery. 2015 ; Vol. 122, No. 3. pp. 557-563.
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N2 - OBJECT: Middle fossa floor dehiscence (MFFD) can present as multiple syndromes depending on dehiscence location, tissue herniation, and dural integrity. The authors propose a classification system for MFFD with the potential to guide clinical decision making.METHODS: A retrospective analysis of the electronic medical records (years 1995-2012) of patients who had undergone temporal craniotomy for the surgical repair of an MFFD syndrome at a single institution was undertaken. Reviewed data included demographic, operative, presentation, and outcome details. Middle fossa floor dehiscence was classified as follows: Class A, bony dehiscence without herniation of the brain and/or meninges; Class B, herniation of the brain and/or meninges through the middle fossa floor without CSF leakage; Class C, dehiscence with CSF leakage without meningitis; or Class D, dehiscence with meningitis.RESULTS: Fifty-one patients, 22 males and 29 females, were included in the analysis. The mean age was 48.7 ± 15.5 years, mean body mass index was 32.65 ± 6.86 kg/m(2), and mean symptom duration was 33 ± 42 months. Seven patients underwent repeat surgery for symptomatic recurrence; therefore, there were 58 surgical encounters. Repair included bony reconstruction with hydroxyapatite with or without resection of encephaloceles and/or repair of a dural defect. According to the MFFD classification system described, 15, 8, 27, and 8 cases were categorized as Class A, B, C, and D, respectively. The prevalence of hearing loss was 87%, 63%, and 70% in Classes A, B, and C, respectively. Vestibular symptoms were more prevalent in Class A. Seven patients reported persistent symptoms at the last follow-up. Transient complications were similar in each classification (13%-25%), and a single permanent complication related to anesthesia was observed. There were no mortalities or severe neurological morbidities in the series.CONCLUSIONS: Middle fossa floor dehiscence has a spectrum of clinical presentations. A classification system may help to clarify the diagnosis and guide therapy. Surgery, the mainstay of treatment, is safe and well tolerated.

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