Medical Student University of Pittsburgh School of Medicine Pittsburgh, Pennsylvania, United States
Introduction: Tegmen defects arise from erosion of the temporal bone and are often associated with obesity-related intracranial hypertension. The extent of the defect can sometimes extend to involve the semicircular canal, but the relationship between the extent of defect has not been well studied using quantified intracranial pressure. This study aimed to report intraoperative lumbar puncture opening pressures in patients with tegmen defects with and without associated SCCD, permitting analysis of defect severity and outcomes.
Methods: Electronic medical records were obtained from 69 patients who underwent surgery for tegmen defects from 2014 to 2022. Variables including intraoperative opening pressure, body mass index (BMI), lumbar drain use duration, and acetazolamide use were collected. Dural venous sinus stenosis was defined on computed tomography venogram.
Results: Of the 61 patients, 62.3% (n=38) were female with a mean age of 57 years (range 28-84). Linear regression demonstrated that opening pressure was positively related to BMI (F=7.4, p< 0.01). Patients with both tegmen defect and SCCD had higher mean opening pressures than (26 vs. 22, p< 0.05), longer post-operative lumbar drain duration (3.0 vs. 2.66 days, p< 0.05), higher rates of dural venous sinus stenosis (26.7% vs. 2.7%, p< 0.05), and increased likelihood of acetazolamide use (73.3% vs. 37.8%, p< 0.05) than patients with tegmen defect alone. Tegmen defect patients who presented with active CSF leak had higher rates of obstructive sleep apnea (42.1% vs. 17.4%, p< 0.05), higher rates of acetazolamide use (57.9% vs. 30.4%, p< 0.05), and had higher rates of adverse outcomes (55.3% vs. 23.9%, p< 0.05) when compared to no leak controls.
Conclusion : This study elucidates a significant correlation between BMI and intracranial hypertension in patients with tegmen defects. Patients with tegmen defect and SCCD exhibit more severe intracranial hypertensive disease, whereas those with concurrent CSF leak tend to experience more adverse outcomes.
