Surgical treatment of difficult cerebrospinal fluid otorhinorrhea

Cerebrospinal fluid (CSF) otorhinorrhea may be a result of infection, congenital abnormality, trauma, or it may be iatrogenic. Despite its etiology, most cases of CSF otorhinorrhea resolve spontaneously or with conservative management. For those instances where the leak does not resolve, a large variety of drainage, packing, and obliteration procedures have been developed in an attempt to stop the CSF drainage and prevent the development of meningitis. Seven cases are reviewed that resulted in complete control of the leak with minimal morbidity. The authors' approach to difficult cerebrospinal fluid otorhinorrhea is presented and described in detail.