Improving Surgical Outcomes in Middle Cranial Fossa Cerebrospinal Fluid Leak Repair.

Abstract

Background: Spontaneous cerebrospinal fluid (CSF) leaks of the temporal bone occur in the absence of known iatrogenic or traumatic injury and without underlying congenital malformation. Holistic treatment of the condition requires meticulous perioperative evaluation of the patient to mitigate underlying risk factors. Similarly, surgery for CSF leaks requires careful consideration of all potential routes of CSF leakage to improve short- and long-term surgical outcomes.

Objective: To describe our surgical technique in this article, which addresses most of the potential routes of spontaneous CSF otorrhea. Perioperative management of the patients is also described.

Methods: A total of 65 patients underwent CSF leak repair using a middle cranial fossa approach and the techniques described in this paper. Their surgical outcomes are described.

Results: Preoperatively, all patients had either biochemically proven beta trace protein-positive CSF otorrhea or the presence of an encephalocele on preoperative imaging. Using this technique, all patients had short-term successful repair of their CSF leak, whereas a long-term success rate of 87.7% was achieved. No major complications were encountered.

Conclusion: Holistic treatment of spontaneous CSF leaks of the temporal bone, together with using a surgical approach that considers all potential routes of CSF leakage, may help to improve long- and short-term surgical outcomes.