Skull Base 2010; 20(4): 253-259
DOI: 10.1055/s-0030-1249249

© Thieme Medical Publishers

Cerebrospinal Fluid Leaks of Temporal Bone Origin: Selection of Surgical Approach

Stanley Pelosi1 , Joshua B. Bederson2 , Eric E. Smouha1
  • 1Department of Otolaryngology–Head and Neck Surgery, The Mount Sinai School of Medicine, New York, New York
  • 2Department of Neurosurgery, The Mount Sinai School of Medicine, New York, New York
Further Information

Publication History

Publication Date:
12 March 2010 (online)


Cerebrospinal fluid leaks of the temporal bone are rare, often occult, and sometimes challenging to localize and repair. This is a retrospective study of eight patients with spontaneous cerebrospinal fluid leak and six patients with cerebrospinal fluid leak or encephalocele discovered during chronic ear surgery who were treated in a tertiary medical center over a 5-year period. All received preoperative temporal bone computed tomography, and six also underwent magnetic resonance imaging, one computed tomography cisternography, and one radionuclide cisternography. All patients initially underwent a transmastoid surgical approach. Additional exposure was necessary in three patients; two underwent middle fossa craniotomy and another required minicraniotomy. Primary surgical repair was successful in six of the eight patients with spontaneous leaks and in all six chronic ear patients. Both recurrences required intradural middle fossa repair. An individualized approach should be taken for repair of temporal bone cerebrospinal fluid leaks. In this series, most were successfully repaired in a single stage using a transmastoid or combined approach. The transmastoid approach provides information about the precise size and location of the dural defect. A primary transcranial approach is needed for defects that are multiple, located in the petrous apex, and in revision cases.


Eric E Smouha, M.D. 

The Mount Sinai Hospital, Otolaryngology - Head and Neck Surgery, One Gustave L. Levy Place

Box 1189 New York New York 10029