Keyhole Brain Surgery Solves Some Ear Infections


PHILADELPHIA, Pa. (Ivanhoe Newswire) – TE is a defect in the part of the skull that separates the brain from the ear. This can cause brain fluid leakage and even meningitis. Now, an innovative endoscopic operation is minimizing the incision and impact on the brain; repairing the problem in little more than an hour of surgery.

Agnes McFadden, mother and grandmother, loves to travel and cook. But three years ago, when her ear began leaking massive amounts of fluid, she had to put her life on hold.

McFadden told Ivanhoe, “My pillows every night were completely covered by the morning.”

Agnes was diagnosed with TE, meaning a hole in her temporal bone, which forms part of the skull, had to be surgically repaired. The pulsating of her brain had created just enough pressure for cerebral fluid to go where it shouldn’t— through a hole in her skull.

Kadir Erkmen, MD, Vice Chairman of Neurosurgery at Temple University explained, “It actually has a shelf and the brain sits on top of it and it’s through that shelf bone that is oftentimes very thin; the brain can have a defect and the bone can have a defect, and so the brain material and fluid from the brain can get into the ear space.”

As soon as her ear infections stopped, Agnes underwent groundbreaking endoscopic keyhole neurosurgery. This unique operation uses tiny cameras inserted through an incision, less than two inches long, to repair the skull.

Pamela Roehm, MD, PhD, Professor; Director, Division of Otology and Neurotology, Department of Otolaryngology at Temple University School of Medicine explained, “Before, we had to make a very large incision, and shave half the head, and then put in retractors that really pushed the brain down, in order to repair these areas.” (Read Full Interview)

This approach using the endoscope was the brain child of Doctors Erkmen and Roehm. It offers better visualization and has very little impact on the healthy tissue. The keyhole surgery uses bone, muscle, and a suture to seal up the hole. Doctors say the defect can be present at birth, caused by a severe head injury, or even be the result of numerous ear infections. But no matter how it happened, Agnes is back to business as usual.

McFadden said, “Wonderful. Like nothing ever happened.”

Doctors say that because a major risk of this condition is the possibility of spinal fluid entering the ear, meningitis can occur. So, if you have recurrent ear infections and antibiotics haven’t worked, be sure to ask your physician about other possible causes, like TE. Agnes’ total recovery time was around three months.

Contributors to this news report include: Donna Parker, Field Producer; Kirk Manson, Videographer; Cyndy McGrath, Supervising Producer; Gabriella Battistiol, Assistant Producer; Jamison Koczan, Editor.

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REPORT:       MB #4379

BACKGROUND: TE is a defect of the skull that over time develops a hole in the temporal bone, the area that separates the ear and the brain. This defect can lead to dangerous consequences, such as the leakage of brain fluid and even meningitis. With TE, the natural pulsations of the brain can create enough pressure for the cerebral fluid to enter areas through the hole in the skull. These fluids can enter the ear canal and cause severe ear infections that will reoccur even after taking antibiotics.

CAUSE: There are many different ways in which TE can develop. It can be present at birth, developed after a traumatic head injury, and even after multiple ear infections. In some cases, it can be developed from simply having a very thin temporal bone. The brain naturally pulsates with every heartbeat 60 to 70 times per minute. When the bone is very thin, the pulsations can break it down, an occurrence usually seen in people who are overweight. TE is detected by the unresponsiveness of the ear infection to antibiotics allowing doctors to conclude that they’re facing a bigger issue than an average ear infection and to proceed with the keyhole brain surgery.

ENDOSCOPIC OPERATION: This innovative procedure consists of small incisions being made to open up the area. Then, a small hole is made for the craniotomy. Bones and extra materials that have to be removed to do the surgery are saved and used later to repair any holes doctors find. The procedure offers a much more effective approach.  A very large incision was made requiring the patients to shave half of their heads to put in retractors that push the brain down because a microscope was used to visualize the area, versus the endoscope currently used during the operation. Typically the surgery lasts at least over three to four hours requiring only a few days for a full recovery.

(Source: Pamela Roehm, MD, PhD)

MORE FROM DR. ROEHM: With this approach doctors can make a much smaller incision, a much smaller craniotomy or hole through the bone around the brain and really get people in and out of the hospital quicker and in a safe fashion, so it is very gratifying to be able to do it.  Dr. Roehm also says the most rewarding thing about it is when they have patients who have had similar repairs elsewhere come back in and say this was so much easier this time.


Jennifer Lee

Pamela Roehm

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Doctor Q and A

Read the entire Doctor Q&A for Pamela Roehm, MD, PhD

Read the entire Q&A