Raymond, Mallory J

Abstract Objective To evaluate whether postoperative intracranial pressure–lowering interventions reduce recurrence of lateral skull base spontaneous cerebrospinal fluid leaks after surgical repair. Data Sources Ovid MEDLINE, Embase, Cochrane CENTRAL, Web of Science Core Collection, and Scopus were searched from inception through April 7, 2025. Review Methods The review followed the Preferred Reporting Items for Systematic Reviews and Meta‐Analyses guidelines and included studies of adults with lateral skull base spontaneous cerebrospinal fluid leaks undergoing primary repair where postoperative intracranial pressure–lowering interventions were specified. Pooled recurrence rates were calculated by intervention type and compared with cohorts that did not receive intracranial pressure–lowering therapy. Results Thirty‐six studies including 687 patients (737 cases) met inclusion criteria. Six comparative cohorts (34 treated, 155 untreated) showed no significant difference in recurrence (risk ratio 1.16, 95% confidence interval [CI]: 0.14–9.76; I 2 = 0%). Across 82 intervention‐only cases, recurrence occurred in three (pooled proportion 0.10, 95% CI: 0.04–0.26; I 2 = 0%). Among 650 control‐only cases, 45 recurred (pooled proportion 0.09, 95% CI: 0.07–0.12; I 2 = 0%). No heterogeneity was observed across pooled analyses. Conclusion Available evidence does not support universal postoperative intracranial pressure–lowering therapy after lateral skull base spontaneous cerebrospinal fluid leak repair. Limited observational data suggest acetazolamide may be associated with lower recurrence, whereas lumbar drainage has not demonstrated sustained benefit. Given the heterogeneity in patient selection and intervention practices, postoperative management should be individualized. Future prospective studies are needed to better define the role of targeted therapy in high‐risk patients.

Objective: To compare the prevalence and patterns of transverse sinus stenosis (TSS) in patients with lateral skull base spontaneous cerebrospinal fluid (sCSF) leaks and idiopathic intracranial hypertension (IIH), to clarify its role in leak pathogenesis and implications for venous-directed therapies. Study design: Retrospective case-control study. Setting: Single tertiary care institution. Patients: Adults with lateral skull base sCSF leaks confirmed by clinical, laboratory, or surgical findings, and adults with IIH without cranial CSF leaks meeting Modified Dandy criteria. Intervention: Independent magnetic resonance venography evaluation by 2 fellowship-trained neuroradiologists. Main outcome measures: Presence, laterality, and severity of TSS. Results: Eighteen patients with sCSF leaks and 78 patients with IIH were included. The rate of individual TSS, including both unilateral and bilateral cases, was higher in the IIH cohort than in the sCSF leak cohort (bilateral TSS: n=66, 84.6% vs. n=6, 33.3%; P <0.001). Severe bilateral TSS was observed more in the IIH cohort (n=40, 51.3%) compared with the sCSF leak cohort (n=1, 5.6%; P <0.001). Conclusions: Though patients with lateral skull base sCSF leaks have TSS, the significantly lower rate compared with patients with IIH suggests that TSS may play a lesser role in the pathogenesis of lateral skull base defects. These findings indicate that the role of transverse sinus stenting in lateral skull base sCSF leaks remains uncertain and highlight the need to further investigate local remodeling processes when considering the role of venous sinus stenting in this population.

Abstract Objective Microscopic surgery assessment tools vary in objectivity and requirements for determining surgical proficiency. Artificial intelligence methods for objective microsurgical analysis have become more common, but their applications to mastoidectomy have not been reconciled with earlier efforts. This scoping review aimed to (1) compile and compare objective features and assessment targets of microscopic surgery analysis tools and (2) inform the development of a standardized annotation framework for mastoidectomy. Data Sources Ovid MEDLINE®, Embase (Ovid), Cochrane Central Register of Controlled Trials (CENTRAL, Ovid), Cochrane Database of Systematic Reviews (Ovid), and Scopus. Review Methods A scoping review of English‐language, full‐text articles describing any objective analysis tool for microscopic surgery performed by participants of any level. Extracted data included procedure type, evaluation modality, and classification into five domains: checklist/rating‐based, instrument motion analysis, error identification, workflow modeling, and artificial intelligence‐assisted feedback. Results Of 2203 screened studies, 52 met the inclusion criteria across otolaryngology, ophthalmology, and neurological surgery. Manual assessments (n = 42, 80.8%) primarily used checklists, rating scales, or end‐product evaluations. Automated assessments (n = 10, 19.2%) incorporated motion tracking and artificial intelligence‐assisted feedback. Otolaryngology contributed 28 tools, 22 of which evaluated mastoidectomy, cochlear implantation, or temporal bone dissection. Virtual reality was the most commonly reported training platform (n = 13). Conclusion Although instrument tracking and artificial intelligence‐assisted feedback have been explored, evaluation of microscopic surgery remains largely manual and subjective, with limited adoption of automated assessment tools. The lack of a standardized framework for automated mastoidectomy assessment represents a potential area for future development.

Objective: To compare postoperative complications between staged versus unstaged tympanoplasty and subtotal petrosectomy (STP) in adults undergoing cochlear implants with noncholesteatoma chronic otitis media (NCCOM) and tympanic membrane perforation. Databases reviewed: PubMed/MEDLINE, Cochrane CENTRAL, Embase, CINAHL, Web of Science, WHO Global Index Medicus, ClinicalTrials.gov, and WHO ICTRP. Materials and methods: A systematic search of databases was conducted by a research librarian from inception through November 18, 2024. Eligible studies for inclusion must have reported on adult cochlear implant recipients undergoing surgical management of NCCOM with perforation. Using a random effects model, complication rates were pooled and compared between staged and unstaged surgeries using relative risk (RR) with 95% CI. Results: Of 1265 studies identified, 19 met inclusion criteria (n = 84). Fifty three (63.1%) patients underwent unstaged surgery. Amongst all patients, STP was performed more than tympanoplasty (72.6%, 61/84 vs 27.4%, 23/84), and the overall complication rate was 11.9% (10/84). There was no significant difference in complication rates between combined staged and unstaged surgeries [RR: 1.13 (95% CI, 0.18-7.04)] as well staged and unstaged tympanoplasty [RR: 0.34 (95% CI, 0.11-0.1.01)]. However, complication rates were lower for staged than unstaged STP [RR: 0 (95% CI, 0.0-0.07)]. Conclusion: Staged and unstaged surgery for NCCOM and cochlear implant may result in comparable complication rates, however the wide CIs for RR statistics in comparisons between combined staged and unstaged procedures as well as staged and unstaged tympanoplasty indicate a need for similar studies of larger populations.

Objective: To estimate the relative risk of meningitis after repair of spontaneous lateral skull base cerebrospinal fluid (CSF) leaks through meta-analysis of published studies. Databases Reviewed: PubMed, Medline, Embase, Cochrane, SCI-EXPANDED, ESCI, Epistemonikos, and WHO Global Index Medicus were queried for terms including and related to meningitis, CSF leak, surgery, and spontaneous from inception to April 02, 2024. Methods: Prospective and retrospective studies in any language reporting either preoperative or postoperative rates of meningitis in adults with spontaneous lateral skull base CSF leaks were included. Two reviewers independently screened 2,564 studies and extracted data and evaluated risk of bias in 57 studies that met inclusion criteria. A random effects generalized linear mixed model was used to pool and compare logit transformed risk of meningitis before and after repair. Results: Of 1,310 patients who met inclusion criteria, 1,239 underwent CSF leak repair. Fifty-two studies reported rates of preoperative meningitis, and 27 studies reported rates of postoperative meningitis. Twenty-two studies with a total of 511 patients reported both rates. The average follow-up period of 17 studies reporting duration of follow-up was 23.1 months. The preoperative pooled risk of meningitis was 0.16 (95% CI: 0.13–0.25, I 2 = 40.57%). The postoperative pooled risk was considerably lower at 0.01 (95% CI: 0.01–0.14, I 2 = 4.16%). With substantial heterogeneity (I 2 = 62.94%), we observed a relative risk of meningitis after repair of 0.02 (95% CI: 0.00–0.79, p = 0.04). Conclusion: Surgical repair of spontaneous lateral skull base CSF leaks may significantly reduce the risk of adult meningitis.

Objective: Assess the impact of adult cochlear implantation on the disability and quality of life (QOL) of communication partners (CP) of cochlear implant (CI) recipients. Databases reviewed: PubMed, MEDLINE, Embase, Cochrane CENTRAL, Science Citation Index Expanded, and Emerging Sources Citation Index were searched. Methods: This study was reported following the preferred reporting items for systematic reviews and meta-analysis (PRISMA) guidelines. Articles included reported on disability or QOL measures of CP of adult CI recipients. Study selection included retrospective, prospective, and randomized controlled studies in English language. Three reviewers independently screened studies for inclusion, extracted data, and evaluated risk of bias. Outcomes included both qualitative and quantitative pre-CI and post-CI measures of CP disability or QOL. Results: Of 1615 screened articles, 9 studies utilizing quantitative and qualitative measures with 504 CP met inclusion criteria. Four of 6 studies assessing only post-CI CP QOL, demonstrated self-reported improvement, while one demonstrated worse CP QOL compared with the general population and one identified CP and CI recipient qualities that correlated with CP QOL scores. Two studies assessing pre-CI to post-CI CP QOL also reported improvements. One study assessing only pre-CI CP QOL suggested that CPs had worse QOL than normal hearing controls. Duration of CI recipient hearing loss did not impact CP QOL in any study. Conclusions: Though homogenous data on the QOL of CPs of CI recipients and the relationship between CI recipient and CP factors is limited, studies suggest that CPs of CI recipients may have worse QOL than the general population but, cochlear implantation may improve CP QOL.

AbstractTemporal bone en plaque meningiomas can present management challenges, particularly when accompanied by severe pain. We report the case of a 42-year-old woman who was initially diagnosed with chronic otitis media but was later found to have a painful left temporal bone en plaque meningioma. Despite conservative therapy, her pain progressed, prompting the decision to undergo surgical resection, which resulted in considerable pain relief. This report illustrates the influence of pain on surgical decision-making for temporal bone en plaque meningiomas and reviews the literature on their variable presentations and management strategies.

Objective: To explore the associations between social determinants of health (SDOH) and the access to, delivery of, and outcomes of cholesteatoma care. Study Design: Retrospective review. Setting: Multisite tertiary care institution. Methods: Seventy-five adults (aged 18–83) with cholesteatoma who completed SDOH questionnaires were included. Outcome measures included SDOH risk factor prevalence (stress, housing instability, financial resource strain, social connectedness, food insecurity, intimate partner violence), disease severity, hearing loss degree at presentation, mean time from symptom onset to diagnosis, postoperative improvements in air-bone gaps (ABG), complication rates, and two-stage surgery rates. Results: Stress (n = 45; 60%) was the most prevalent SDOH risk factor. Females (n = 23; 79.3%; P = 0.05; d = –0.24]), younger adults (mean age = 45; P = 0.01; d = –0.69), and individuals with lower education (n = 23; 82.1%; P = 0.04; d= –0.26) were more likely to have at least one SDOH risk factor. Patients with SDOH risk factors had better preoperative air pure tone averages (mean [SD] = 39.7 [16]; P = 0.01; d = –0.69) than patients without SDOH risk factors (mean [SD] = 50.1 [13.5]); but the ABG was similar between groups (P = 0.16; d = –0.38). No differences were identified in any measure of cholesteatoma care between patients with and without SDOH risk factors. Conclusion: Stress is a prevalent SDOH risk factor among patients with cholesteatoma, but it might not influence cholesteatoma care. Though female sex, younger age, and lower education levels were associated with having at least one SDOH risk factor, these also might not influence cholesteatoma care. Intentional study of larger, more heterogeneous populations is necessary to validate these observations.