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An algorithm for the surgical approach to spontaneous temporal bone CSF leak.

Ophir Handzel1, Omer J Ungar1

  • 1Department of Otolaryngology Head and Neck Surgery and Maxillofacial Surgery, Tel-Aviv Sourasky Medical Center, Tel Aviv, Israel; Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel.

American Journal of Otolaryngology
|July 26, 2024
PubMed
Summary

This study proposes a surgical algorithm for temporal bone cerebrospinal fluid (CSF) leaks. The middle fossa approach is effective, with transmastoid options for complex cases.

Keywords:
CSF leakCSF leak repairIdiopathic intracranial hypertension

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Area of Science:

  • Neurosurgery
  • Otolaryngology
  • Skull Base Surgery

Background:

  • Temporal bone cerebrospinal fluid (CSF) leaks are challenging surgical problems.
  • Previous approaches lacked a standardized algorithm for surgical correction.
  • Patients present with active CSF leak or recurrent bacterial meningitis.

Purpose of the Study:

  • To propose a comprehensive surgical algorithm for temporal bone CSF leaks.
  • To evaluate the efficacy of different surgical approaches.
  • To guide surgical planning for primary and revision cases.

Main Methods:

  • A case series of 46 patients (51 temporal bones) operated between 2011 and 2022.
  • Patients presented with active CSF leak (38) or otogenic meningitis (8).
  • Surgical approaches included middle fossa and transmastoid techniques.

Main Results:

  • The middle fossa approach achieved an 88% success rate in sealing CSF leaks.
  • No intracranial complications or sensorineural hearing loss were reported with the middle fossa approach.
  • Transmastoid approaches were indicated for specific defect characteristics and in revision cases; subtotal petrosectomy with obliteration was used in revisions.

Conclusions:

  • The middle fossa approach serves as a reliable default for temporal bone CSF leak repair.
  • Specific indications exist for transmastoid approaches in primary and revision surgeries.
  • The proposed algorithm aids in surgical planning for temporal bone CSF leaks and otogenic meningitis.