Surgical Management of Spontaneous CSF Leaks Involving the Temporal Bone

Background: Spontaneous CSF otorrhea is uncommon but may result in potentially life-threatening complications including meningitis or pneumocephalus. Diagnosis is often delayed due the typical presentation mimicking chronic serous otitis media. Objective: To describe the patient demographics, modalities of presentations, and techniques in the surgical management in spontaneous cerebrospinal fluid (CSF) otorrhea. Study Design: Retrospective review at a tertiary referral center. Material and Methods: Patients that presented with spontaneous CSF otorrhea over 18-year period who were surgically managed were included. Clinical case notes and operative notes were reviewed to obtain information on patient demographics, clinical presentation, investigations, operative techniques, and postoperative follow-up. Results: Total 15 patients that underwent 16 procedures (1 patient underwent bilateral procedure) were included in the review. The mean age of presentation was 52 years; male to female ratio was 4:11. The clinical presentations were varied (otorrhea, recurrent meningitis, hearing loss, rhinorrhoea, and pneumocephalus). A combined mastoidectomy and middle fossa craniotomy was performed using a combination of allogenic and autologous materials in all cases. Conclusions: A joint (otolaryngology and neurosurgery) combined approach provides an adequate and safe exposure with several advantages and in our series provided a 100% primary success rate.