Cerebrospinal Fluid Leak Prevention After Translabyrinthine Removal of Vestibular Schwannoma

Abstract

The use of proper surgical technique minimizes the risk of CSF leak. Study results show that the continued application of the authors' proposed preventive measures resulted in the maintenance of a low rate of CSF leak. Immediate management of CSF fistulae helps prevent meningitis.

Eustachian Tube Obliteration and its Effect on Rhinoliquorrhea in Translabyrinthine Vestibular Schwannoma Excision

“…From the control group, CSF leaks were reported only in individuals who had a pneumatization of level 2 or more. Moreover, as reported in other studies [8][9][10] , we found a correlation between pneumatization level and CSF leaks, and this relationship was independent of tumor size.…”

“…Many variations in the technique of translabyrinthine VS surgery have been introduced to improve its outcome [7,9,20] . As previously mentioned, CSF rhinorrhea may occur if a communication exists between the middle ear space and the ET.…”

“…Current literature perpetuates the existing discord, as the efficacy of ET obliteration is inconsistent from one study to another. Whereas some have shown that a meticulous enlarged translabyrinthine approach [8,9] or a Palva flap technique [10] have the potential to reduce CSF leaks, others report no difference in CSF rhinorrhea rates even though they obliterated the ET [28] . In our previous study, we found a statistically significant decrease in the rate of CSF leaks in patients who had undergone ET obliteration as compared to people who did not [22] .…”

“…The advent of the translabyrinthine approach has improved the management of VS [7] , despite the fact that some postoperative complications remain considerable. This is the case of cerebrospinal fluid (CSF) leaks [8][9][10] , the second most common complication of VS resection [10,11] . Although its incidence is negligible in some studies, it can reach as much as 20% in others, and even more so when considering only large tumors [7,8,12] .…”

“…Although its incidence is negligible in some studies, it can reach as much as 20% in others, and even more so when considering only large tumors [7,8,12] . CSF leaks results from a communication way that takes place between the subarachnoid space, the mastoid air cells, the middle ear, the petrous apex air cells, and finally either the Eustachian tube (ET), the surgical incision, or a tear in the tympanic membrane [7][8][9][10][12][13][14][15][16][17] . Consequently, the complication can respectively manifest as a rhinoliquorrhea, a wound discharge or an otorrhea [8,18] .…”