Comparison of Spontaneous Temporal Bone Cerebrospinal Fluid Leaks From the Middle and Posterior Fossa

Abstract

Objectives: To compare patients surgically managed for spontaneous cerebrospinal fluid (CSF) leaks of the temporal bone arising from the middle cranial fossa (MCF) and posterior cranial fossa (PCF) and to describe the surgical management of posterior fossa CSF leaks. Study Design: Retrospective case review. Setting: Academic tertiary center. Patients: Adult patients presenting with spontaneous temporal bone CSF leaks undergoing operative repair between January 2010 and August 2018. Patients with a history of trauma, previous mastoid surgery, and iatrogenic CSF leaks were excluded. Intervention: Transmastoid or MCF CSF leak repair. Main Outcome Measures: Patient demographics, body mass index (BMI), comorbidities, presenting features, and lumbar puncture opening pressures were compared between groups and the management of the PCF CSF leaks described. Results: Forty-six patients (26 women, 20 men) were included. The mean age at the time of repair was 58.0 ± 12.9 years (±SD). The origin of the CSF leak was from the PCF in three patients and MCF in 43 patients. All three patients with PCF leaks presented with an acute history of meningitis compared with only seven (16%) in the MCF group. This difference was statistically significant (p = 0.01, Fisher's exact test). There were no statistically significant differences in age, sex, BMI, or lumbar puncture opening pressures. The PCF leaks were repaired using a transmastoid approach with multilayer closure of the bony defect and fat graft obliteration of the mastoid. Conclusions: Spontaneous CSF leaks arising from the PCF are rare and may present more commonly with meningitis. Identification requires careful review of imaging.

A Unique Subset: Idiopathic Intracranial Hypertension Presenting as Spontaneous CSF Leak of the Anterior Skull Base

“…Additionally, this study was confined only to spontaneous CSF leaks of the anterior skull base. Spontaneous CSF leaks, associated with underlying IIH pathophysiology, are also well-known to arise within the middle and posterior fossa, 4 52 53 and we suspect there is overlap of their management, particularly after surgical repair, with the findings discussed in this review. However, we chose to limit our literature review to anterior skull base defects, based on our institutional experience of combined neurosurgery and otolaryngology involvement for anterior skull base defects only.…”

Cerebrospinal Fluid Leaks From the Lateral Ventricle: A Case Series

“…Notably, 2 of 3 patients presented with meningitis, a much higher rate than that of LSB CSF-L patients overall (2,6,9). In a recent series, 16% of patients with spontaneous middle fossa CSF leaks presented with meningitis as opposed to 100% of posterior fossa leaks (40). One could hypothesize that patients with encephalomalacia and a dehiscence communicating into the lateral ventricle potentially have less of a physical barrier for intracranial spread of infection (mirroring that of posterior fossa defects) than those that arise in association with obesity/elevated ICP.…”

Post-traumatic cerebrospinal fluid rhinorrhea and Transcranial approach surgical outcomes.

“…Cooper T19 46 patients (26 female and 20 male). Emergence of the cerebrospinal fluid (CSF) leakage documented from Posterior Cranial Fossa in three patients three patient and Middle Cranial Fossa in those 7 patients the Posterior Cranial Fossa leaks presented with meningitis compared with only 7 in the Middle Cranial Fossa group.…”