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Surgical management of spontaneous cerebrospinal fluid leakage through temporal bone defects—case series and review of the literature

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Abstract

Increasing numbers of cases of idiopathic cerebrospinal fluid (CSF) leakage through temporal bone defects (TBD) have been recently reported, mainly in otolaryngologic journals. Those cases are referred to as spontaneous temporal bone encephaloceles (TBE). Three surgical approaches have been advocated for this condition: the transmastoid approach (TMA), the middle cranial fossa approach (MCFA), or a combination of both. We conducted a retrospective study of all 11 consecutive patients who underwent 12 middle cranial fossa craniotomies for the treatment of CSF leakage through TBD in our institution between 2011 and 2014. Neurosurgical and otologic data were collected from the patients’ records. Nine of our cases had an idiopathic etiology. No CSF leaks recurred during an average follow-up of 19.5 months. There was one case of a postoperative expressive aphasia with complete recovery in a few weeks. A systematic literature search was conducted for all studies addressing the treatment of spontaneous TBE between 1986 and 2013. It revealed a trend favoring the use of the MCFA approach over the TMA approach, with an acceptable risk of less than 5 % for craniotomy-related complications. We concluded that MCFA is an effective and safe technique for the repair of CSF leakage through TBD. A high percentage of complete resolution with a low complication rate can be achieved with this surgical technique.

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Acknowledgments

We would like to express our deepest gratitude for the help and support of Ms. Esther Eshkol for her comments and remarkable work in checking and editing this study

Conflict of interest

The authors declare that they have no competing interests.

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No funding has been received for this study.

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Authors and Affiliations

  1. Department of Neurosurgery, Tel Aviv Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel

    Lior Gonen, Nir Shimony & Nevo Margalit

  2. Department of Otolaryngology/Head, Neck and Maxillofacial Surgery, Tel Aviv Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel

    Ophir Handzel & Dan M. Fliss

Authors
  1. Lior Gonen
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  2. Ophir Handzel
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  3. Nir Shimony
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  4. Dan M. Fliss
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  5. Nevo Margalit
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Corresponding author

Correspondence to Nevo Margalit.

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Comments

Kwan Park and Doo-Sik Kong, Seoul, Korea

This study is regarding surgical management of spontaneous cerebrospinal fluid leakage through temporal bone defects. To reconstruct the temporal base defect is challenging issue for neurosurgeons and otolaryngologists. Before making decision of optimal surgical technique, it is essential to identify the accurate location of CSF leaks and to confirm radiological /nuclear imaging. The authors performed excellent middle cranial fossa approach with a rotation of a pedicled strip of the temporal muscle and fascia for the temporal bone base defect leading to spontaneous cerebrospinal fluid leakage. Successful achievement of this surgical approach requires in-depth knowledge about the skull base anatomy and more dexterous management. In particular, making rotated muscle strip and preservation of remaining main bulk of the temporal muscle are critical point of this surgical approach. Nowadays, several novel materials covering dural defect have been developed and produced. These products composing of collagen materials, synthetic repair materials, bovine/porcine tissues, or human allografts can be applied to the on-lay graft and even to the in-lay graft. We believe more innovative materials can substitute for the use of autograft in the future.

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Gonen, L., Handzel, O., Shimony, N. et al. Surgical management of spontaneous cerebrospinal fluid leakage through temporal bone defects—case series and review of the literature. Neurosurg Rev 39, 141–150 (2016). https://doi.org/10.1007/s10143-015-0665-8

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  • DOI: https://doi.org/10.1007/s10143-015-0665-8

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