Prevention and management of cerebrospinal fluid fistula after transtemporal skull base surgery

The incidence of cerebrospinal fluid (CSF) fistula after transtemporal skull base surgery can range from 4% to 19%. The risk of CSF leak may be related to tumor size and location, the extent of the dural defect, and the technical aspects of the wound reconstruction. Prevention of meningitis depends on the early detection and management of CSF leakage. Five hundred eighty-nine patients underwent a variety of transtemporal surgical approaches for the extirpation of skull base tumors at our institution from July 1988 to October 1999. The medical records were reviewed retrospectively to identify the tumor histology, size, and location, as well as the surgical approach, defect reconstruction technique, and the incidence of postoperative CSF leak. The risk of CSF fistulae was greatest in using the retrosigmoid approach (8%) and lowest in those who underwent a translabyrinthine approach (4%). Tumor size had no bearing on the incidence of the CSF leak and the overall incidence of meningitis was 1.0%. This article outlines our institutional objective for the prevention and management of CSF fistula after transtemporal skull base surgery. Illustrative cases will be presented.