Book review
https://doi.org/10.20471/acc.2022.61.s4.12
Rhinogenic Meningitis Caused by Congenital Petrous Apex Cholesteatoma: Simultaneous Surgical Treatment through Transotic and Transsphenoidal Approach
Mateo Čukman
orcid.org/0000-0002-6780-931X
; Department of Otorhinolaryngology and Head & Neck Surgery, Sestre milosrdnice University Hospital Center, Zagreb, Croatia
Jakov Ajduk
orcid.org/0000-0003-3648-0280
; Department of Otorhinolaryngology and Head & Neck Surgery, Sestre milosrdnice University Hospital Center, Zagreb, Croatia; University of Zagreb, School of Medicine, Zagreb, Croatia
Luka Bukovac
orcid.org/0000-0001-7559-7137
; University of Zagreb, School of Medicine, Zagreb, Croatia
Marko Velimir Grgić
orcid.org/0000-0003-4196-5303
; Department of Otorhinolaryngology and Head & Neck Surgery, Sestre milosrdnice University Hospital Center, Zagreb, Croatia; University of Zagreb, School of Medicine, Zagreb, Croatia
Abstract
A 66-year-old male patient was admitted due to high fever, severe headaches
and disturbance of consciousness. Meningitis was confirmed by lumbar puncture and intravenous
antimicrobial therapy was started. Since he had undergone radical tympanomastoidectomy 15 years
before, otogenic meningitis was suspected, so the patient was referred to our department. Clinically,
the patient manifested watery discharge from the right nostril. Microbiological analysis verified
Staphylococcus aureus in a cerebrospinal fluid (CSF) sample acquired by lumbar puncture. Radiological
work-up, including computed tomography and magnetic resonance imaging scans, showed an
expanding lesion of the petrous apex of the right temporal bone disrupting the posterior bony wall
of the right sphenoid sinus with radiological characteristics indicating cholesteatoma. Those findings
confirmed rhinogenic meningitis caused by expansion of the petrous apex congenital cholesteatoma
into the sphenoid sinus, allowing nasal bacteria to enter the cranial cavity. The cholesteatoma was
removed completely by the simultaneous transotic and transsphenoidal approach. Since the right labyrinth
was already non-functional, there was no surgical morbidity after labyrinthectomy. The facial
nerve remained preserved and intact. The transsphenoidal approach enabled removal of the sphenoid
portion of the cholesteatoma and two surgeons met together at the level of the retrocarotid segment
of the cholesteatoma, completely removing the lesion. This case represents an extremely rare condition
in which a petrous apex congenital cholesteatoma expanded through the petrous apex to the sphenoid
sinus, causing CSF rhinorrhea and rhinogenic meningitis. According to available literature, this is the
first case of petrous apex congenital cholesteatoma causing rhinogenic meningitis successfully treated
with the simultaneous transotic and transsphenoidal approach.
Keywords
Petrous apex; Congenital cholesteatoma; Rhinogenic meningitis; Simultaneous approach, transotic; Transsphenoidal
Hrčak ID:
292399
URI
Publication date:
31.10.2022.
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