Management of Dural Injury During Mastoidectomy

Abstract

Adequate measures to manage hemorrhage and liquorrhea are important for safe performance of mastoidectomy. While hemorrhage and liquorrhea from the middle cranial fossa are relatively frequently encountered during mastoidectomy, management of massive hemorrhage from the sigmoid sinus and liquorrhea from the posterior cranial fossa is often very challenging. Continuous liquorrhea can cause intra-cranial infections, such as meningitis and brain abscess.

Among the 880 patients who had undergone ear surgery with mastoidectomy for such conditions as chronic otitis media, cholesteatoma, and decompression of the facial nerve over a 20-year period at our instruction, we analyzed the surgical data of 33 cases that had developed hemorrhage and 20 cases that had developed liquorrhea during mastoidectomy.

Based on a review of the data, we consider that multilayer obliteration is more reliable than simple obliteration. There was one case each of pneumocephalus and meningitis developing as postoperative intracranial complications, and in both cases, the condition resolved with conservative treatment.