Anatomical Variation in Sigmoid Sinus and Its Impact on Mastoid Exploration in Atticoantral Chronic Suppurative Otitis Media Surgery: A Prospective Study at Khyber Teaching Hospital, Peshawar: Sigmoid Sinus Variations and Their Impact on Mastoid Surgery in CSOM

Wasim Sajjad; Muhammad Aimen Ikram; Hafiz Danyal Khan; Adeeba Zahid; Furqan Ijaz; Hafiz Hamza Mahmood; Rahmatullah Khan

doi:10.54393/pjhs.v6i11.3384

Authors

Wasim Sajjad Department of ENT, Khyber Teaching Hospital, Peshawar, Pakistan
Muhammad Aimen Ikram Department of ENT, District Headquarters Teaching Hospital, Kohat, Development Authority, Kohat, Pakistan
Hafiz Danyal Khan Khyber Medical College, Peshawar, Pakistan
Adeeba Zahid Khyber Medical College, Peshawar, Pakistan
Furqan Ijaz Department of ENT, District Headquarters Teaching Hospital, Kohat, Development Authority, Kohat, Pakistan
Hafiz Hamza Mahmood Khyber Medical College, Peshawar, Pakistan
Rahmatullah Khan Department of ENT, Hayatabad Medical Complex, Peshawar, Pakistan

DOI:

https://doi.org/10.54393/pjhs.v6i11.3384

Keywords:

Otitis Media Suppurative, Cholesteatoma, Anatomic Variation, Temporal Bone, Mastoidectomy

Abstract

Atticoantral Chronic Suppurative Otitis Media (CSOM) with cholesteatoma frequently causes intraoperative complications. Anatomical variations of the sigmoid sinus (SS) can increase surgical risk. This study correlates CT-identified SS variations with operative challenges and outcomes, addressing the limited literature on their specific impact. Objectives: To evaluate the anatomical variations of the sigmoid sinus on preoperative CT scans and determine their impact on intraoperative challenges and postoperative outcomes during mastoid exploration for atticoantral chronic suppurative otitis media. Methods: This analytical cross-sectional study of 300 patients undergoing radical mastoidectomy at a tertiary care hospital from January to December 2024. Temporal bone CT scans assessed variation in SS position and bony plate integrity. Intraoperative and postoperative complications were recorded. Categorical data were analyzed using chi chi-square test (p<0.05). Results: CT evaluation demonstrated intact bony plates in 77.3% of cases, with 12.3% showing erosion and 11.3% exhibiting exposure; sinus position was posterior in 63%, anterior in 25%, and normotopic in 12%. Intraoperative observations matched CT findings. Anterior displacement was significantly associated with increased surgeon fatigue (p = 0.014), Dural injury (p < 0.001), significant hemorrhage (p=0.032), facial nerve palsy (p=0.006), and incomplete disease clearance (p < 0.001). Eroded or exposed plates also correlated with higher complication rates (p<0.01). No postoperative meningitis occurred. Conclusions: Preoperative CT accurately predicts sigmoid sinus variations in atticoantral CSOM, aiding surgical planning and reducing intraoperative complications.

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