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Contribution to the Bony Obliteration Tympanoplasty Technique and the Diffusion Weighted MR Imaging to Safety and Success in Cholesteatoma Management

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Contribution to the Bony Obliteration Tympanoplasty Technique and the Diffusion Weighted MR Imaging to Safety and Success in Cholesteatoma Management Contribution to the Bony Obliteration Tympanoplasty Technique and the Diffusion Weighted MR Imaging to Safety and Success in Cholesteatoma Management Printed by: Ipskamp Drukkers Lay-out: Diny Helsper Art-work: Elena Del Castillo – Ideas2Earth.com ISBN 978-90-813121-6-5 © J.-P. Vercruysse Contribution to the Bony Obliteration Tympanoplasty Technique and the Diffusion Weighted MR Imaging to Safety and Success in Cholesteatoma Management Thesis Radboud University Nijmegen Medical Centre, Nijmegen. All rights reserved. No part of this publication may be reproduced in any form or by any means, electronically, mechanically, by print or otherwise without written permission of the copyright owner. Contribution to the Bony Obliteration Tympanoplasty Technique and the Diffusion Weighted MR Imaging to Safety and Success in Cholesteatoma Management Proefschrift ter verkrijging van de graad van doctor aan de Radboud Universiteit Nijmegen op gezag van de rector magnificus prof. dr. J.H.J.M. van Krieken, volgens besluit van het college van decanen in het openbaar te verdedigen op maandag 28 november 2016 om 14.30 uur precies door Jean-Philippe Louis Pierre William Vercruysse geboren op 27-04-1976 te Wilrijk, België Promotor(en): Prof dr. C.W.R.J. Cremers Prof. dr. F.E. Offeciers, KU Leuven Copromotor: Dr. B. De Foer, St. Augustinus Ziekenhuis, Antwerpen, België. Manuscriptcommissie; Prof. dr. C. Hoyng Prof. dr. J. Magnan, Université Aix-Marseille, Frankrijk Dr. S. Steens Every day you may make progress. Every step may be fruitful. Yet there will stretch out before you an ever-lengthening, ever-ascending, ever-improving path. You know you will never get to the end of the journey. But this, so far from discouraging, only adds to the joy and glory of the climb. Winston Churchill Table of contents Chapter 1 Introduction 11 Chapter 1.1 General introduction 13 1. Definition and history of cholesteatoma 2. Epidemiology 3. Classification of cholesteatoma a. Congenital cholesteatoma b. Acquired cholesteatoma 4. Diagnosis of cholesteatoma a. CT imaging b. MR imaging 5. Surgery of cholesteatoma 6. Lowering residual and recurrent disease 7. Purpose of the thesis Chapter 1.2 Game-changers in chronic otitis media with 45 cholesteatoma Vercruysse JP, van Dinther J, De Foer B, Casselman J, Offeciers E, Cremers C. Submitted for publication Chapter 2 Cholesteatoma – Surgical principles 51 Chapter 2.1 Mastoid and epitympanic obliteration. The obliteration 53 technique. Offeciers E, Vercruysse JP, De Foer B, Casselman JW, Somers T. In: Ars B, ed. Chronic Otitis Media. Pathogenesis Oriented Therapeutic Treatment. Amsterdam: Kugler, (2008);299–327 Chapter 3 Cholesteatoma - Imaging principles 89 Chapter 3.1 MRI of cholesteatoma. 91 De Foer B, Vercruysse JP, Offeciers E, Casselman J. Recent Advances in Otolaryngology 8 (Eds J. Keir, D. Moffat, H. Sudhoff). Royal Society of Medicine Press Ltd (1 Mar 2008): pp 1-23 Chapter 3.2 Magnetic Resonance Imaging of cholesteatoma: an 117 update. Vercruysse JP, De Foer B, Somers T, Casselman JW, Offeciers E. B-ENT (2009): 233-240 Chapter 3.3 Diffusion-weighted magnetic resonance imaging of the 131 temporal bone. De Foer B, Vercruysse JP, Spaepen M, Somers T, Pouillon M, Offeciers E, Casselman JW. Neuroradiology (2010) 52(9):785-807 Chapter 4 Contribution of diffusion weighted MR imaging in 171 clinical cholesteatoma management Chapter 4.1 The value of diffusion-weighted MR imaging in the 173 diagnosis of primary acquired and residual cholesteatoma: a surgical verified study of 100 patients. Vercruysse JP, De Foer B, Pouillon M, Somers T, Casselman J, Offeciers E. Eur Radiol (2006) 16: 1461-1467 Chapter 4.2 Value of high-resolution computed tomography and 189 magnetic resonance imaging in the detection of residual cholesteatomas in primary bony obliterated mastoids. De Foer B, Vercruysse JP, Pouillon M, Somers T, Casselman J, Offeciers E. AJO (2007) 28: 230-234 Chapter 4.3 Detection of postoperative residual cholesteatoma with 203 non-echo-planar diffusion-weighted magnetic resonance imaging. De Foer B, Vercruysse JP, Bernaerts A, Deckers F, Pouillon M, Somers T, Casselman J, Offeciers E. Otology & Neurotology (2008) 29: 513-517 Chapter 4.4 Middle ear cholesteatoma: non-echo-planar diffusion 217 weighted MR imaging versus delayed gadolinium- enhanced T1 weighted MR imaging De Foer B, Vercruysse JP, Bernaerts A, Meersschaert J, Kenis C, Pouillon M, De Beuckeleer L, Michiels J, Bogaerts K, Deckers F, Somers T, Hermans R, Offeciers E, Casselman J. Radiology (2010) 255: 866-872 Chapter 5 Contribution of bony obliteration techniques in clinical 231 cholesteatoma management: short term results Chapter 5.1 Mastoid and epitympanic bony obliteration in pediatric 233 cholesteatoma. Vercruysse JP, De Foer B, Somers T, Casselman J, Offeciers E. Otology & Neurotology (2008) 29: 953-960 Chapter 6 Contribution of bony obliteration techniques in clinical 251 cholesteatoma management: long-term results Chapter 6.1 Long-term follow-up after bony mastoid and epitympanic 253 obliteration: radiological findings. Vercruysse JP, De Foer B, Somers T , Casselman J, Offeciers E. Journal of Laryngology and Otology (2010) 124: 37-143 Chapter 6.2 Long-term results of troublesome CWD cavity 269 reconstruction by mastoid and epitympanic bony obliteration (CWR-BOT) in adults Vercruysse JP, Van Dinther J, De Foer B, Casselman J, Somers T, Cremers C, Offeciers E. Otology & Neurotology (2016) 37:698-703 Chapter 7 Discussion 287 Samenvatting / Summary / Résumé 297 Acknowledgements 321 Curriculum Vitae 325 List of publications 327 List of abbreviations 331 The manuscript has mainly been written in UK-English with the exception of some chapters, which contain articles that have been published in American journals. In order to safeguard the authenticity of the published papers, the original format was preserved and not changed from US -English to UK- English. Chapter 1 Introduction Chapter 1.1 General Introduction General Introduction 15 1. Definition and history of cholesteatoma A cholesteatoma is defined as a hyperproliferative disease of keratinocytes characterised by mass formation due to accumulation of continuous desquamation of keratin, leading to local invasive destruction of surrounding tissues (1). The first description of a cholesteatoma was made by a French anatomist JG Duverney in 1683, describing the presence of sheets of tissue in a fistulised mastoid causing hearing loss, a postauricular fistula and foetid discharge from the external meatus (2-3). Müller was the first to describe in 1838 the term cholesteatoma as he became aware of the presence of cholesterin and fat in what he believed to be a tumour (4). Müller also noticed the resemblance between the squamae of cholesteatoma and the cells of the stratum corneum of the skin, but he did not correlate this with a possible epidermal origin of cholesteatoma. The term cholesteatoma, although fundamentally incorrect, persists until today. 2. Epidemiology The incidence of cholesteatoma is 3 per 100,000 in children and 9.2 per 100,000 in adults, with a male predominance of 1.4/1. Although middle ear cholesteatomas are more present in younger individuals, external auditory canal cholesteatomas present predominantly at a later age (40–70y). There is a higher prevalence among white individuals, and cholesteatoma is rarely detected in the Asian, American Indian and Alaskan Eskimo population (5). 3. Classification of cholesteatoma Theoretically there are two types of aural cholesteatoma (Figure 1): congenital (A) and acquired cholesteatoma (B). Congenital cholesteatoma is characterized by the presence of a white pearl of keratinized epithelium behind an intact tympanic membrane (TM) in absence of prior surgery, inflammation, perforation or trauma (6). The majority of acquired cholesteatomas arise when a retraction of the tympanic membrane occurs into the attic and/or posterior mesotympanum, leading to epithelial accumulation and ultimately to an acquired cholesteatoma. 16 Chapter 1.1 Figure 1. Micro-otoscopy of an acquired pars flaccida cholesteatoma (left) and a congenital cholesteatoma (right). A. Congenital cholesteatoma 1. Theories of origin and embryology House published the first case of a primary or congenital cholesteatoma in 1953 (7). Derlacki and Clemis (6) described six cases of congenital cholesteatoma and first established clinical criteria for the diagnosis of congenital cholesteatoma. A congenital cholesteatoma was defined as an epithelial inclusion cyst behind an intact TM in a patient without antecedent history of otitis media. According to the criteria by Levenson et al., a history of prior otitis media no longer excludes the diagnosis of a congenital cholesteatoma (8). Several theories have been introduced regarding the pathogenesis of a congenital cholesteatoma. In the ectoderm migration theory (9), the ectoderm from the primitive ear canal passes through or around the tympanic ring to enter the middle ear space. The metaplasia theory suggests that otitis media or other inflammatory middle ear processes result in squamous metaplasia leading to keratin formation (10). Another theory from Northrop et al., called the amniotic cell migration theory, suggested that viable squamous epithelial cells found in amniotic fluid in the middle ear could be a potential source for congenital cholesteatoma (11). The invagination theory or acquired inclusion theory by Tos, states that inflammation in the middle ear causes a portion of the tympanic membrane to invaginate, trapping epithelium in the middle
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