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Surgical management of spontaneous middle cranial fossa defects: a systematic review and meta-analysis of available reconstructive techniques and materials

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Abstract

Different materials and techniques have been proposed for surgical repair of spontaneous middle cranial fossa (MCF) defects. However, conclusive evidence supporting their selection and impact on clinical outcomes is lacking. The study aims to conduct a systematic review and meta-analysis on materials and techniques employed to repair MCF defects and evaluate complications and rates of recurrent cerebrospinal fluid (CSF) leaks. A PRISMA-guided systematic review and meta-analysis were performed using MESH terms and specific keywords including studies published before May 2022. Primary outcomes included recurrence of CSF leak and complication rates by type of reconstructive material and technique utilized. Meta-analyses of proportions were performed using random effects and confidence intervals for individual proportions were calculated using the Clopper-Pearson method. Twenty-nine studies were included (n = 471 cases). Materials employed for repair were categorized according to defect size: 65% of defects were of unknown size, 24% were small (< 1 cm), and 11% were large (≥ 1 cm). Rigid reconstruction (RR) was significantly favored over soft reconstruction (SR) for larger defects (94% of cases, p < 0.05). Complications and recurrent CSF leak rates of SR and RR techniques were comparable for defects of all sizes (p > 0.05). Complication rates reported for these procedures are low regardless of technique and material. RR was universally preferred for larger defects and analysis of complication and recurrence rates did not reveal differences regardless of defect size. While RR was more frequently reported in smaller defects, SR was used by several centers, particularly for smaller MCF floor defects.

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The authors confirm that the data supporting the findings of this study are available within the article and its supplementary materials.

Abbreviations

CSF:

Cerebrospinal fluid

JBI:

Joanna Briggs Institute

MCF:

Middle cranial fossa

MCFA:

Middle cranial fossa approach

RR:

Rigid reconstruction

SR:

Soft reconstruction

TMA:

Transmastoid approach

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Authors and Affiliations

  1. Department of Neurosurgery, Emory University, Atlanta, GA, USA

    Edoardo Porto, Hanyao Sun, J. Manuel Revuelta-Barbero, Tomas Garzon-Muvdi & Gustavo Pradilla

  2. Neuroscience Research Group (NeURos), School of Medicine and Health Sciences, Universidad del Rosario, Bogotá, Colombia

    Ivan Pradilla

  3. Unidad de Investigación, Fundación Universitaria Sanitas, Bogotá, D.C, Colombia

    Maria A. Palacios-Ariza

  4. Department of Otorhinolaryngology-Head and Neck Surgery, Emory University, Atlanta, GA, USA

    Nathalia Velasquez, C. Arturo Solares, Douglas E. Mattox & Esther Vivas

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  1. Edoardo Porto
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Contributions

Conceptualization, methodology, and investigation: E. P., H. S., J. M. R. B., and G. P. Formal analysis: N. V., D. E. M., E. X. V., and G. P. Writing — original draft preparation: E. P., H. S., I. P., and M. P. Statistical analyses: I. P. and M. P. Writing — review and editing: E. P., H. S., C. A. S., and T. G. M. Final supervision: E. P., H. S., and G. P.

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Correspondence to Gustavo Pradilla.

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Competing interests

Authors associated with this submission do have financial conflicts of interest to disclose: Gustavo Pradilla is a consultant for Stryker Corporation and C. Arturo Solares is a consultant for Stryker Corporation. The other authors do not have financial disclosures.

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Gustavo Pradilla is a consultant for Stryker Corporation. C. Arturo Solares is a consultant for Medtronic. The other authors do not have financial disclosures.

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Edoardo Porto and Hanyao Sun are first co-authors.

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Porto, E., Sun, H., Revuelta-Barbero, J.M. et al. Surgical management of spontaneous middle cranial fossa defects: a systematic review and meta-analysis of available reconstructive techniques and materials. Neurosurg Rev 46, 41 (2023). https://doi.org/10.1007/s10143-023-01947-z

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