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Vol. 67, No. 1, 2005
Issue release date: 2005

Cerebrospinal Fluid Leaks of Temporal Bone Origin: Etiology and Management

Stenzel M. · Preuss S. · Orloff L. · Jecker P. · Mann W.
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Abstract

Background: Cerebrospinal fluid (CSF) leaks of the temporal bone region require surgical treatment as they pose life-threatening risks such as meningitis. Aim: The aim of the study was to determine the surgical outcome depending on different operation techniques and grafts. Method: We performed a retrospective review of 28 cases of CSF leaks, operated in our department from 1983 to 2002. After a mean follow-up of 8 years, patients were interviewed concerning otorrhea or rhinorrhea and meningitis. In this context, our management of CSF leaks is presented. Results: The CSF leak had arisen spontaneously (n = 3), traumatically (n = 6) or postoperatively (n = 19). The surgical CSF leak repairs were performed via a transmastoid (n = 13), a middle fossa (n = 11) or a combined (n = 4) approach. Surgical outcome was independent on the used graft. CSF leak could be sealed in 25 of 28 cases. Only 3 patients suffered from recurrences. Meningitis or other complications did not occur. Conclusions: Comparing different techniques and grafts, there were no differences in the surgical outcome.



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References

  1. Neely JG: Classification of spontaneous cerebrospinal fluid middle ear effusion: Review of forty-nine cases. Otolaryngol Head Neck Surg 1985;93:625–634.
  2. Windfuhr JP, Sesterhenn K: Spontaneous defects of the lateral skull base. 2. Etiology and review of the literature. HNO 2002;50:441–463.
  3. Wetmore SJ, Herrmann P, Fisch U: Spontaneous cerebrospinal fluid otorrhea. Am J Otol 1987;8:96–102.
  4. Gacek RR, Leipzig B: Congenital cerebrospinal otorrhea. Ann Otol Rhinol Laryngol 1979;88:358–365.
  5. Rich PM, Graham J, Phelps PD: Hyrtl’s fissure. Otol Neurotol 2002;23:476–482.
  6. Petrus LV, Lo WW: Spontaneous CSF otorrhea caused by abnormal development of the facial nerve canal. AJNR Am J Neuroradiol 1999;20:275–277.
  7. Hoppe F, Hagen R, Hofmann E: Fistula of stapes footplate caused by pulsatile cerebrospinal fluid in inner ear malformation. ORL J Otorhinolaryngol Relat Spec 1997;59:115–118.
  8. Gacek RR, Gacek MR, Tart R: Adult spontaneous cerebrospinal fluid otorrhea: Diagnosis and management. Am J Otol 1999;20:770–776.
  9. Gacek RR, Gacek MR: Arachnoid granulations of the temporal bone. Am J Otol 1999;20:405–406.
  10. Gacek RR: Evaluation and management of temporal bone arachnoid granulations. Arch Otolaryngol Head Neck Surg 1992;118:327–332.
  11. Dutt SN, Mirza S, Irving RM: Middle cranial fossa approach for the repair of spontaneous cerebrospinal fluid otorrhoea using autologous bone pate. Clin Otolaryngol 2001;26:117–123.
  12. Lundy LB, Graham MD, Kartush JM, LaRouere MJ: Temporal bone encephalocele and cerebrospinal fluid leaks. Am J Otol 1996;17:461–469.
  13. Ferguson BJ, Wilkins RH, Hudson W, Farmer J Jr: Spontaneous CSF otorrhea from tegmen and posterior fossa defects. Laryngoscope 1986;96:635–644.
  14. Valtonen H, Geyer C, Tarlov E, Heilman C, Poe D: Tegmental defects and cerebrospinal fluid otorrhea. ORL J Otorhinolaryngol Relat Spec 2001;6346–6352.
  15. Chaplin JM, Costantino PD, Wolpoe ME, Bederson JB, Griffey ES, Zhang WX: Use of an acellular dermal allograft for dural replacement: An experimental study. Neurosurgery 1999;45:320–327.
  16. Costantino PD, Wolpoe ME, Govindaraj S, Chaplin JM, Sen C, Cohen M, Gnoy A: Human dural replacement with acellular dermis: Clinical results and a review of the literature. Head Neck 2000;22:765–771.
  17. Warren WL, Medary MB, Dureza CD, Bellotte JB, Flannagan PP, Oh MY, Fukushima T: Dural repair using acellular human dermis: Experience with 200 cases: Technique assessment. Neurosurgery 2000;46:1391–1396.
  18. Meddings N, Scott R, Bullock R, French DA, Hide TA, Gorham SD: Collagen vicryl – A new dural prosthesis. Acta Neurochir (Wien) 1992;117:53–58.
  19. Narotam PK, Van Dellen JR, Bhoola K, Raidoo D: Experimental evaluation of collagen sponge as a dural graft. Br J Neurosurg 1993;7:635–641.
  20. Mello LR, Feltrin LT, Fontes Neto PT, Ferraz FA: Duraplasty with biosynthetic cellulose: An experimental study. J Neurosurg 1997;86:143–150.
  21. Hoshi K, Yoshino H, Urata J, Nakamura Y, Yanagawa H, Sato T: Creutzfeldt-Jakob disease associated with cadaveric dura mater grafts in Japan. Neurology 2000;55:718–721.
  22. Thammavaram KV, Benzel EC, Kesterson L: Fascia lata graft as a dural substitute in neurosurgery. South Med J 1990;83:634–636.
  23. Reddy M, Schoggl A, Reddy B, Saringer W, Weigel G, Matula C: A clinical study of a fibrinogen-based collagen fleece for dural repair in neurosurgery. Acta Neurochir (Wien) 2002;144:265–269.
  24. Sierra DH, Nissen AJ, Welch J: The use of fibrin glue in intracranial procedures: Preliminary results. Laryngoscope 1990;100:360–363.
  25. Shaffrey CI, Spotnitz WD, Shaffrey ME, Jane JA: Neurosurgical applications of fibrin glue: Augmentation of dural closure in 134 patients. Neurosurgery 1990;26:207–210.


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