Transmastoid Approach to Temporal Bone Cerebrospinal Fluid (CSF) Leaks Repair: A Single-Center 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. Temporal bone CSF leaks can be repaired via a middle cranial fossa (MCF), transmastoid (TM) or combined approach. While the MCF approach allows an enhanced exposure to the tegmen and improved 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 experience of using the transmastoid approach as an option for CSF leak repairs.

Objectives: The objective of this study is to report on a single center’s experience of the use of the TM approach for temporal bone CSF leak repairs.

Methods: A retrospective analysis was conducted on twelve consecutive patients with temporal bone CSF leaks who underwent surgical repair at our institution between 2018 and 2021. Patient demographics, surgical details, postoperative complications, and outcomes were collected and analyzed.

Results: Twelve patients underwent TM approach, involving a small retro-auricular incision and minimal bone removal. A multilayered repaired was completed using temporalis muscle fascia and tissue sealant. Mean age was 55.9 (SD: 12.4). Six patients (50%) were male. There were no immediate or long term post-operative complications. CSF leak repair was successful with only the TM approach in 10/12 cases (83%). 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 7 of 12 (66%) 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 non-inferior 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 and without major complications, similar to prior reported series. 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.

 

MissingLinkText

No conflict of interest has been declared by the author(s).

Publication History

Article published online:
05 February 2024