Dangers of a False Sense of Security in a Huge Mastoid Cholesteatoma With Skull Base Erosion and Cerebrospinal Fluid Leakage

Chin-Lung Kuo

doi:10.24983/scitemed.aohns.2020.00134

Abstract

The author reports a case involving a 59-year-old man with delayed presentation of a huge mastoid cholesteatoma complicated by skull base erosion and cerebrospinal fluid leakage. Delayed presentation of this disease entity can have negative health consequences for patients. Regular otologic examinations, audiologic follow-up, and imaging examinations are viewed as the most effective strategies for the prevention of this type of situation. Early recognition of cholesteatomas is essential, as appropriate and timely treatment can prevent this rare comorbid condition from becoming fatal.

Highlights

Cholesteatoma is defined as an accumulation of exfoliated keratin produced from stratified squamous epithelium in the middle ear without a previous history of ear infection, head trauma, or ear surgery [1,2]
We report an exceptional case of a patient with delayed presentation of a massive cholesteatoma complicated by skull base erosion and cerebrospinal fluid (CSF) leakage
We initiated removal of the cholesteatoma piece by piece; persistent CSF leakage was identified during this procedure

Summary

INTRODUCTION

Cholesteatoma is defined as an accumulation of exfoliated keratin produced from stratified squamous epithelium in the middle ear without a previous history of ear infection, head trauma, or ear surgery [1,2]. We report an exceptional case of a patient with delayed presentation of a massive cholesteatoma complicated by skull base erosion and cerebrospinal fluid (CSF) leakage. Surgical exploration and a subsequent histopathology examination revealed a huge cholesteatoma (Figure 1E and Video 1) tightly adhered to the outer dura of the left posterior cranial fossa (Figure 2). We initiated removal of the cholesteatoma piece by piece; persistent CSF leakage was identified during this procedure. This complication was rectified by grafting a commercially available collagen matrix graft over the leak (DuraGen® Plus). A hearing test revealed severe bilateral mixed hearing loss at all frequencies, and a CT scan revealed a huge soft tissue mass in the mastoid of the left ear (asterisk in Figures 1B and 1C) as well as bony defects in the skull

DISCUSSION

CONCLUSIONS