Repair of Cerebrospinal Fluid Leaks of the Temporal Bone Via a Transmastoid Approach: An Updated Single Center’s Experience

Introduction: Temporal bone cerebrospinal fluid (CSF) leaks present with nonspecific symptoms of aural fullness, hearing loss, tinnitus, imbalance, and headaches. They pose a significant challenge in neurosurgery, requiring meticulous repair to prevent complications such as infection, meningitis, cranial nerve deficits, and seizures. CSF leaks can be repaired via a middle cranial fossa (MCF), transmastoid (TM), or a combined approach. While the MCF approach allows an enhanced exposure to the tegmen and preservation of hearing, the TM approach has the advantage of access to both tegmen and posterior fossa plate while avoiding a traditional craniotomy and temporal bone retraction. Herein, we report on our updated experience of using the trans-mastoid approach as a first option for CSF leak repairs.

Objectives: The objective of this study is to expand our previously reported data from a single center’s experience of the use of the TM approach to the repair of temporal bone CSF leaks.

Methods: A retrospective analysis was conducted on 12 consecutive patients with temporal bone CSF leaks who underwent surgical repair at our institution between 2018 and 2023. Patient demographics, surgical details, postoperative complications, and outcomes were collected and analyzed.

Results: Eighteen patients underwent TM approach, involving a small retro-auricular incision and minimal bone removal. Mean age was 59.7 (SD: 11.3). Ten patients (56%) were female. There were no immediate or long term postoperative complications. CSF leak repair was successful with only the TM approach in 16/18 cases (89%). One patient underwent MCF as a rescue procedure following recurrence of CSF leak. One patient required placement of a ventriculoperitoneal shunt given a large defect and history of idiopathic intracranial hypertension. Stable to improved hearing was reported in 11/18 (61%) cases. There were no mortalities in this series.

Conclusion: The TM approach to repair temporal bone CSF leaks can be highly successful and in select cases can be noninferior to the traditional intracranial MCF approach. While the MCF approach affords the ability to inspect the entire middle fossa floor and better hearing preservation, it does so at the expense of temporal lobe retraction. Our study demonstrates that the TM approach to temporal bone CSF leak repairs is a safe technique with comparable recurrence rates of prior reported series. In addition, hearing preservation is achievable in a large proportion of patients. Further research and long-term follow-up studies are warranted to confirm the enduring benefits of this approach and its potential applicability in a broader range of neurosurgical procedures.

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Artikel online veröffentlicht:
07. Februar 2025