Repair of Middle Fossa Cerebrospinal Fluid Leaks Using a Novel Combination of Materials: A Technical Note

Objective: To evaluate the safety and durability of our repair technique for middle fossa cerebrospinal fluid (MCSF) leaks using a combination of three synthetic materials.

Design: A retrospective chart review of patients treated from January 2009–September 2011.

Methods: Inclusion criteria for the study included: age >18 years old, documented temporal bone defect on neuroimaging, and symptoms consistent with a cerebrospinal fluid (CSF) leak or gross CSF otorrhea following myringotomy. Hydroxyapatite cement (HAC), collagen-based dural substitute matrix (DURAFORM, Codman & Shurtleff, Inc., Raynham, MA, USA), and polyethylene glycol (PEG) hydrogel sealant (DuraSeal, Confluent Surgical, Inc., Waltham, MA, USA) were used in all repairs.

Results: Eight patients underwent a middle fossa craniotomy for CSF leaks. Seven patients, three males and four females, met the inclusion criteria, and their charts were reviewed. Initial presenting symptoms were CSF otorrhea (4/7, 57.1%), hearing loss (2/7, 28.6%), and CSF rhinorrhea (1/7, 14.3%). MCSF leaks were successfully repaired in all patients. The average postoperative follow-up was 12 months (range, 5–33 months) with a total of 149 follow-up months. During the follow-up period, there were no wound infections, signs of neurovascular damage, or CSF leaks requiring reoperation.

Conclusion: The middle fossa approach in combination with hydroxyapatite cement, DURAFORM, and DuraSeal is a safe, effective method for repairing MCSF leaks. This combination of synthetic materials provides an alternative for skull base surgeons to previously described methods.