Temporal Bone Encephaloceles: Utility of Preoperative Imaging

Objective To determine the diagnostic efficacy and clinical value of preoperative computed tomography (CT) and magnetic resonance imaging (MRI) among patients with suspected temporal bone encephaloceles (TBE). Study Design Retrospective chart review from 2006 to 2018. Setting Tertiary referral cente...

Full description

Saved in:
Bibliographic Details
Published in:Otolaryngology-head and neck surgery 2020-09, Vol.163 (3), p.577-581
Main Authors: Worrall, Douglas M., Pai, Akila, Garneau, Jonathan C., Perez, Enrique R., Cosetti, Maura K., Smouha, Eric E., Wanna, George B.
Format: Article
Language:English
Subjects:
Adult
Aged
cerebrospinal fluid fistula
cerebrospinal fluid leak
Cerebrospinal Fluid Leak - complications
Cerebrospinal Fluid Leak - diagnostic imaging
Cerebrospinal Fluid Leak - surgery
computed tomography
encephalocele
Encephalocele - complications
Encephalocele - diagnostic imaging
Encephalocele - surgery
Female
Humans
imaging
Magnetic Resonance Imaging
Male
meningitis
Middle Aged
Retrospective Studies
Sensitivity and Specificity
temporal bone
Temporal Bone - diagnostic imaging
temporal bone encephalocele
Tomography, X-Ray Computed
Citations: Items that this one cites
Items that cite this one
Online Access:Get full text
Tags: Add Tag
No Tags, Be the first to tag this record!
Description
Summary:Objective To determine the diagnostic efficacy and clinical value of preoperative computed tomography (CT) and magnetic resonance imaging (MRI) among patients with suspected temporal bone encephaloceles (TBE). Study Design Retrospective chart review from 2006 to 2018. Setting Tertiary referral center. Subjects and Methods The subjects underwent surgery for a clinically suspected TBE or cerebrospinal fluid (CSF) leak. Preoperative imaging test characteristics of CT and MRI, including sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV), were calculated for TBE scans and compared with intraoperative findings. Results Fifty-seven subjects with otorrhea, middle ear effusion, hearing loss, and/or meningitis with suspected TBE or CSF leak were identified. All had preoperative CT scans, and 61% (35/57) had preoperative MRI scans. Intraoperatively, 37 of 57 patients (65%) were found to have a TBE. CT scans (17% sensitivity, 100% specificity, 100% PPV, 46% NPV) were less sensitive than MRI (58% sensitivity, 100% specificity, 100% PPV, 24% NPV) for detecting TBEs. Furthermore, the time from initial scan to operative repair was significantly longer in those who had a CT followed by MRI scan compared with CT alone or a fused CT-MRI scan (mean = 68 vs 15 days, respectively; P = .004). Conclusion CT and MRI provide complementary information that may aid surgical planning. However, imaging cannot always rule out TBE. In cases with high clinical suspicion, surgical confirmation is often required for definitive diagnosis and treatment. The cost of an additional preoperative study should be considered before its use.
ISSN:0194-5998
1097-6817
DOI:10.1177/0194599820918566