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80th Annual Meeting of the German Society of Oto-Rhino-Laryngology, Head and Neck Surgery

German Society of Oto-Rhino-Laryngology, Head and Neck Surgery

20.05. - 24.05.2009, Rostock

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Meningitis as initial presentation of bilateral spontaneous dehiscences of the lateral skull base in two cases

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  • corresponding author Alexander Thiele - HNO-Klinik, Universität Halle/Saale, Halle/Saale, Germany
  • Sabrina Kösling - Klinik für diagnostische Radiologie, Universität Halle/Saale, Halle/Saale, Germany
  • Tobias Müller - Klinik für Neurologie, Universität Halle/Saale, Halle/Saale, Germany
  • Kerstin Neumann - Klinik für HNO, Universität Halle/Saale, Halle/Saale, Germany
  • Stephan Knipping - Klinik für HNO, Städtisches Klinikum Dessau, Dessau, Germany

German Society of Oto-Rhino-Laryngology, Head and Neck Surgery. 80th Annual Meeting of the German Society of Oto-Rhino-Laryngology, Head and Neck Surgery. Rostock, 20.-24.05.2009. Düsseldorf: German Medical Science GMS Publishing House; 2009. Doc09hno111

doi: 10.3205/09hno111, urn:nbn:de:0183-09hno1119

Published: July 22, 2009

© 2009 Thiele et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by-nc-nd/3.0/deed.en). You are free: to Share – to copy, distribute and transmit the work, provided the original author and source are credited.

Outline

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Background: Spontaneous dehiscences of the lateral skull base are a not uncommon finding in cadaver studies. Clinical signs may be a persistent middle ear effusion or conductive hearing loss. The most significant complication and sometimes initial presentation of persistent cerebrospinal fluid leakage is a bacterial meningitis.

Materials and methods: In this retrospective analysis we report on two patients with meningitis caused by pneumococci. Radiologic examination showed bilateral dehiscences in the lateral skull base in both cases. Medical treatment was performed in the years 2006 and 2007 in the Martin-Luther-University Halle/Wittenberg, Germany.

Results: The initial CT-scan showed an unilateral mastoidal opacification. Afterwards a high-resolution CT of the temporal bone approved bony dehiscences of the tegmen tympani or mastoideum in both cases on both sides. An infection per continuitatem was assumed. Within the surgical exploration through a transmastoidal approach in one case the radiological findings could be confirmed. A sufficient repair was obtained using multilayered technique. In the other case a conservative treatment at intensive care unit was successful.

Conclusion: Spontaneous dehiscences of the lateral skull base present an anatomical variation with meningitis as an uncommon initial clinical sign. A high-resolution CT-scan of the temporal bone is essential for the exact diagnosis. Normally a transmastoidal approach is adequate for successful surgery. We recommend the application of temporalis fascia, fibrin glue and bone meal in context of multilayered closure.