Cerebrospinal Fluid Leakage from the Lateral Skull Base: Experiences and Proposed Treatment Protocol

Objective: To describe our experiences in repair of CSF leaks from the lateral skull base and present our treatment protocol.

Study Design: Retrospective case series in an academic, tertiary medical center.

Methods: Following the outcome of treated patients (n = 12) we designed a treatment protocol.

Results: In case of spontaneous CSF otorrhoea, the presence of idiopathic intracranial hypertension has to be considered; if present, this can be treated with medication. If the leakage persists, placement of a lumboperitoneal drain or ventriculoperitoneal drain could be considered, possibly combined with a surgical closure of the defect. In case of an otological operation in the past, a meningoencephalocele may be found from which the leakage arises. Surgical treatment of the leakage may be performed through the mastoid; however, one must also be prepared to perform a middle cranial fossa approach.

Conclusions: The proposed treatment protocol has proved to be effective in our practice for all patients.