Skull Base 2010; 20(4): 253-259
DOI: 10.1055/s-0030-1249249
ORIGINAL ARTICLE

© Thieme Medical Publishers

Cerebrospinal Fluid Leaks of Temporal Bone Origin: Selection of Surgical Approach

Stanley Pelosi1 , Joshua B. Bederson2 , Eric E. Smouha1
  • 1Department of Otolaryngology–Head and Neck Surgery, The Mount Sinai School of Medicine, New York, New York
  • 2Department of Neurosurgery, The Mount Sinai School of Medicine, New York, New York
Weitere Informationen

Publikationsverlauf

Publikationsdatum:
12. März 2010 (online)

ABSTRACT

Cerebrospinal fluid leaks of the temporal bone are rare, often occult, and sometimes challenging to localize and repair. This is a retrospective study of eight patients with spontaneous cerebrospinal fluid leak and six patients with cerebrospinal fluid leak or encephalocele discovered during chronic ear surgery who were treated in a tertiary medical center over a 5-year period. All received preoperative temporal bone computed tomography, and six also underwent magnetic resonance imaging, one computed tomography cisternography, and one radionuclide cisternography. All patients initially underwent a transmastoid surgical approach. Additional exposure was necessary in three patients; two underwent middle fossa craniotomy and another required minicraniotomy. Primary surgical repair was successful in six of the eight patients with spontaneous leaks and in all six chronic ear patients. Both recurrences required intradural middle fossa repair. An individualized approach should be taken for repair of temporal bone cerebrospinal fluid leaks. In this series, most were successfully repaired in a single stage using a transmastoid or combined approach. The transmastoid approach provides information about the precise size and location of the dural defect. A primary transcranial approach is needed for defects that are multiple, located in the petrous apex, and in revision cases.

REFERENCES

  • 1 Brodie H A, Thompson T C. Management of complications from 820 temporal bone fractures.  Am J Otol. 1997;  18 188-197
  • 2 Wootten C T, Kaylie D M, Warren F M, Jackson C G. Management of brain herniation and cerebrospinal fluid leak in revision chronic ear surgery.  Laryngoscope. 2005;  115 1256-1261
  • 3 Gacek R R, Gacek M R, Tart R. Adult spontaneous cerebrospinal fluid otorrhea: diagnosis and management.  Am J Otol. 1999;  20 770-776
  • 4 Scurry Jr W C, Ort S A, Peterson W M, Sheehan J M, Isaacson J E. Idiopathic temporal bone encephaloceles in the obese patient.  Otolaryngol Head Neck Surg. 2007;  136 961-965
  • 5 LeVay A J, Kveton J F. Relationship between obesity, obstructive sleep apnea, and spontaneous cerebrospinal fluid otorrhea.  Laryngoscope. 2008;  118 275-278
  • 6 Skedros D G, Cass S P, Hirsch B E, Kelly R H. Beta-2 transferrin assay in clinical management of cerebral spinal fluid and perilymphatic fluid leaks.  J Otolaryngol. 1993;  22 341-344
  • 7 Raine C. Diagnosis and management of otologic cerebrospinal fluid leak.  Otolaryngol Clin North Am. 2005;  38 583-595, vii
  • 8 Stone J A, Castillo M, Neelon B, Mukherji S K. Evaluation of CSF leaks: high-resolution CT compared with contrast-enhanced CT and radionuclide cisternography.  AJNR Am J Neuroradiol. 1999;  20 706-712
  • 9 Savva A, Taylor M J, Beatty C W. Management of cerebrospinal fluid leaks involving the temporal bone: report on 92 patients.  Laryngoscope. 2003;  113 50-56
  • 10 Pappas D G, Hoffman R A, Holliday R A, Hammerschlag P E, Pappas D G, Swaid S N. Evaluation and management of spontaneous temporal bone cerebrospinal fluid leaks.  Skull Base Surg. 1995;  5 1-7
  • 11 Rao A K, Merenda D M, Wetmore S J. Diagnosis and management of spontaneous cerebrospinal fluid otorrhea.  Otol Neurotol. 2005;  26 1171-1175
  • 12 Stenzel M, Preuss S, Orloff L, Jecker P, Mann W. Cerebrospinal fluid leaks of temporal bone origin: etiology and management.  ORL J Otorhinolaryngol Relat Spec. 2005;  67 51-55
  • 13 Dutt S N, Mirza S, Irving R M. Middle cranial fossa approach for the repair of spontaneous cerebrospinal fluid otorrhoea using autologous bone pate.  Clin Otolaryngol Allied Sci. 2001;  26 117-123
  • 14 Patel R B, Kwartler J A, Hodosh R M, Baredes S. Spontaneous cerebrospinal fluid leakage and middle ear encephalocele in seven patients.  Ear Nose Throat J. 2000;  79 372-373, 376–378
  • 15 Brown N E, Grundfast K M, Jabre A, Megerian C A, O'Malley Jr B W, Rosenberg S I. Diagnosis and management of spontaneous cerebrospinal fluid-middle ear effusion and otorrhea.  Laryngoscope. 2004;  114 800-805
  • 16 Sanna M, Fois P, Paolo F, Russo A, Falcioni M. Management of meningoencephalic herniation of the temporal bone: personal experience and literature review.  Laryngoscope. 2009;  119 1579-1585
  • 17 May J S, Mikus J L, Matthews B L, Browne J D. Spontaneous cerebrospinal fluid otorrhea from defects of the temporal bone: a rare entity?.  Am J Otol. 1995;  16 765-771

Eric E SmouhaM.D. 

The Mount Sinai Hospital, Otolaryngology - Head and Neck Surgery, One Gustave L. Levy Place

Box 1189 New York New York 10029

eMail: eric.smouha@mountsinai.org