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J Neurol Surg B Skull Base 2018; 79(05): 451-457
DOI: 10.1055/s-0037-1617439
Original Article
Georg Thieme Verlag KG Stuttgart · New York

Transmastoid Repair of Spontaneous Cerebrospinal Fluid Leaks

Enrique Perez
1   Department of Otolaryngology Head and Neck Surgery, Mount Sinai Hospital, New York, New York, United States
,
Daniel Carlton
1   Department of Otolaryngology Head and Neck Surgery, Mount Sinai Hospital, New York, New York, United States
,
Matthew Alfarano
2   Rosalind Franklin University of Medicine and Science, North Chicago, Illinois, United States
,
Eric Smouha
1   Department of Otolaryngology Head and Neck Surgery, Mount Sinai Hospital, New York, New York, United States
› Author Affiliations
Further Information

Publication History

15 October 2017

19 November 2017

Publication Date:
11 January 2018 (online)

Also available atMedOne
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Abstract

Objective Determine the efficacy of using a purely transmastoid approach for the repair of spontaneous cerebrospinal fluid (CSF) leaks and further elucidate the relationship of elevated body mass index (BMI) and skull base thickness in our patient population.

Method We conducted a retrospective chart review of patients treated for spontaneous temporal bone CSF leaks at our tertiary care institution from the years 2006 to 2015. Cases were categorized as primary or secondary. We analyzed success rates, length of stay, use of lumbar drains, BMIs, and rates of meningitis. Skull base thickness was compared with BMI in each case.

Results We identified 26 primary operations for spontaneous CSF leaks and 7 secondary operations. Twenty-three of 33 repairs were performed via the transmastoid approach alone with an 87% success rate (20/23). Of the10 repairs including a middle cranial fossa (MCF) or combined MCF-transmastoid approach, 2 failed for an 80% success rate (8/10). Five transmastoid repairs underwent placement of a lumbar drain versus all 10 repairs employing an intracranial exposure. Average length of stay for those undergoing a transmastoid approach (1.7 days) was significantly shorter than for patients undergoing a MCF repair (6.3 days). Four patients presented with meningitis. Average BMI was 35.3. No correlation was established between BMI and skull base thickness (R 2 = 0.00011).

Conclusion The transmastoid approach is effective in the majority of cases and prevents the need for an intracranial operation, resulting in lower morbidity and a shorter length of stay. We believe that this is the preferred primary approach in most patients with spontaneous CSF leaks.

Keywords

encephalocele - middle cranial fossa - body mass index - length of stay - lumbar drains - transmastoid - spontaneous cerebrospinal fluid leak