Our Experience in the Management of CSF Otorrhea in Two Cases: A Transmastoid Approach with Middle Ear Cavity Obliteration and a Middle Cranial Fossa Approach

Objective: Otogenic cerebrospinal fluid (CSF) leakage originates from the defects in the temporal bone. The leakage can be classified as traumatic and spontaneous.

Methods: This study consists of a retrospective review of two patients whose tegmen tympani defects were surgically repaired in our department. CSF otorrhea based on inner ear abnormalities, iatrogenic causes and malignancy were excluded. Informed consent were obtained.

Results: A 34-year-old man presented with conductive hearing loss and House Brackmann grade 2 facial palsy due to falling down from balcony 25 years ago was diagnosed through computed tomography and magnetic resonance imaging. A large tegmen tympani defect accompanied with brain tissue herniation was seen. He underwent surgery using transmastoid approach. After excising the herniated tissue with bipolar cautery a multilayer repair consisting of auricular cartilage, bone pate, fibrin glue and cellulose polymer and a mastoid cavity obliteration using abdominal fat and temporalis muscle was performed. After 30 months he has no relapse.

A 50-year-old woman, who developed permanent clear otorrhea following tympanostomy tube insertion, underwent radiological evaluation which resulted the diagnosis of tegmen tympani defect and CSF fistula. A middle cranial fossa approach in which cortical bone, temporalis muscle fascia, fibrin glue, and Gelfoam were used in a multilayer manner was performed. After a short post-operative clinical course she is also doing well.

Conclusion: Transmastoid and middle cranial fossa approaches are both effective surgical procedures for CSF otorrhea and should be preferred according to the relevant recommendations.