Management of Cerebrospinal Fluid Leaks Involving the Temporal Bone: Report on 92 Patients

Savva, Athanasia; Taylor, Matthew J.; Beatty, Charles W.

doi:10.1097/00005537-200301000-00010

Cited by 154 publications

(177 citation statements)

References 16 publications

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“…20,21 CT findings are often nonspecific since incidental tegmen defects are a ubiquitous finding in the general population and the radiological appearance of encephalocele and CSF effusion replicate that of chronic otitis media, contributing to the potential for diagnostic delay. Since there is a perceived risk of intracranial infection with encephalocele and CSFF, it is generally agreed that persistent lesions mandate surgical repair.…”

Section: Discussionmentioning

confidence: 99%

“…Surgical repair is recommended to decrease the risk of impending neurological complications. 3,20,21 Osseous erosion or bony insufficiency may result from trauma, prior surgery, long-standing infection, or destructive processes such as cholesteatoma or tumor. Over the last 2 decades, there has been a substantial increase in the number of reported "spontaneous" cases, where no discernable cause can be identified.…”

mentioning

confidence: 99%

“…1,8,22,26 Given the rarity of the studied conditions, few large series exist in the literature, and optimal surgical management remains controversial. 7,14,15,20,21 Treatment options include the transmastoid approach with tegmen repair or tympanomastoid obliteration, subtemporal middle fossa craniotomy, or a combined mastoid-middle fossa approach. Repairs may incorporate intradural or extradural overlay or underlay techniques utilizing a variety of autologous and synthetic substrates.…”

mentioning

confidence: 99%

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Temporal bone encephalocele and cerebrospinal fluid fistula repair utilizing the middle cranial fossa or combined mastoid–middle cranial fossa approach

Carlson¹,

Copeland

Driscoll

et al. 2013

JNS

116

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Object The goals of this study were to report the clinical presentation, radiographic findings, operative strategy, and outcomes among patients with temporal bone encephaloceles and cerebrospinal fluid fistulas (CSFFs) and to identify clinical variables associated with surgical outcome. Methods A retrospective case series including all patients who underwent a middle fossa craniotomy or combined mastoid–middle cranial fossa repair of encephalocele and/or CSFF between 2000 and 2012 was accrued from 2 tertiary academic referral centers. Results Eighty-nine consecutive surgeries (86 patients, 59.3% women) were included. The mean age at time of surgery was 52.3 years, and the left side was affected in 53.9% of cases. The mean delay between symptom onset and diagnosis was 35.4 months, and the most common presenting symptoms were hearing loss (92.1%) and persistent ipsilateral otorrhea (73.0%). Few reported a history of intracranial infection (6.7%) or seizures (2.2%). Thirteen (14.6%) of 89 cases had a history of major head trauma, 23 (25.8%) were associated with chronic ear disease without prior operation, 17 (19.1%) occurred following tympanomastoidectomy, and 1 (1.1%) developed in a patient with a cerebral aqueduct cyst resulting in obstructive hydrocephalus. The remaining 35 cases (39.3%) were considered spontaneous. Among all patients, the mean body mass index (BMI) was 35.3 kg/m2, and 46.4% exhibited empty sella syndrome. Patients with spontaneous lesions were statistically significantly older (p = 0.007) and were more commonly female (p = 0.048) compared with those with nonspontaneous pathology. Additionally, those with spontaneous lesions had a greater BMI than those with nonspontaneous disease (p = 0.102), although this difference did not achieve statistical significance. Thirty-two surgeries (36.0%) involved a middle fossa craniotomy alone, whereas 57 (64.0%) involved a combined mastoid–middle fossa repair. There were 7 recurrences (7.9%); 2 patients with recurrence developed meningitis. The use of artificial titanium mesh was statistically associated with the development of recurrent CSFF (p = 0.004), postoperative wound infection (p = 0.039), and meningitis (p = 0.014). Also notable, 6 of the 7 cases with recurrence had evidence of intracranial hypertension. When the 11 cases that involved using titanium mesh were excluded, 96.2% of patients whose lesions were reconstructed with an autologous multilayer repair had neither recurrent CSFF nor meningitis at the last follow-up. Conclusions Patients with temporal bone encephalocele and CSFF commonly present with persistent otorrhea and conductive hearing loss mimicking chronic middle ear disease, which likely contributes to a delay in diagnosis. There is a high prevalence of obesity among this patient population, which may play a role in the pathogenesis of primary and recurrent disease. A middle fossa craniotomy or a combined mastoid–middle fossa approach incorporating a multilayer autologous tissue technique is a safe and reliable method of repair that may be particularly useful for large or multifocal defects. Defect reconstruction using artificial titanium mesh should generally be avoided given increased risks of recurrence and postoperative meningitis.

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Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

mentioning

confidence: 99%

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Temporal bone encephalocele and cerebrospinal fluid fistula repair utilizing the middle cranial fossa or combined mastoid–middle cranial fossa approach

Carlson¹,

Copeland

Driscoll

et al. 2013

JNS

116

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“…Lumbar drains are a safe and well-tolerated adjunct to the various watertight dural closures advocated. 20,21 In this study, there was a statistically significant lower rate of postoperative CSF leakage in patients with a preoperatively placed lumbar drain. The various comorbidities investigated did not contribute to an increased incidence of CSF leak.…”

Section: Discussionmentioning

confidence: 54%

Utilization of Preoperative Cerebrospinal Fluid Drain in Skull Base Surgery

Bien¹,

Bowdino²,

Moore

et al. 2007

Skull Base

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Objective: Retrospectively assess the efficacy of lumbar cerebrospinal fluid (CSF) drainage placed preoperatively in skull base operations in decreasing the incidence of postoperative CSF fistula. Methods: A retrospective review of 150 patients undergoing a posterior fossa craniotomy from 1989 to 2000 was conducted. Patients were divided into those receiving preoperative lumbar drains and those that did not. The rates of postoperative CSF leakage were compared between the two groups. Patient data were analyzed to determine if there were other comorbidities affecting the postoperative incidence of CSF leakage such as smoking, diabetes, or hypertension. Results: Between 1989 and 1994, 25/72 (35%) patients with no preoperative lumbar drain had a postoperative CSF leak. From 1995 to 2000, 9/78 (12%) patients with a preoperative lumbar drain had a CSF leak. This was a 23% decreased incidence of postoperative CSF leakage and a significant decrease in the probability (p < 0.001) of CSF leakage in patients treated with a preoperative lumbar drain. The comorbidities of diabetes, smoking, or hypertension did not increase the probability of a CSF leak (p ¼ 0.43). Conclusions: A preoperatively placed lumbar drain can significantly lower the rate of postoperative CSF leakage after skull base surgery. The drain is a welltolerated adjunct to dural closure and helps increase surgical exposure of the posterior fossa. The comorbidities of diabetes, smoking, or hypertension do not contribute to an increased rate of CSF leakage.

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“…These groups of patients are active community groups, and this could be due to a higher prevalence of high-risk behavior in these age groups. These statistics are varying in different societies; results show that the most common brain injury is related to the third decade of life in developed countries (20)(21)(22)(23). Chiu et al revealed that the most common age group 20-29 years in Taiwan (24) and in a study that done in Norway, the most common head injury was reported in the 0-4 and above 75 years age groups.…”

Section: Discussionmentioning

confidence: 99%

Epidemiological, Clinical and Radiological Characteristics of Patients with Head Trauma

Moghadam-Ahmadi

Vakilian

Farahmand

et al. 2017

IMMINV

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Background: Head injury has been recognized as a major public health problem and is a frequent cause of death and disability in young people and makes considerable demands on health services. Motor vehicle accidents are the major causes of traumatic brain injury (TBI) that its occurrence has been increasing in our country in recent years. We decided to study head injury in our region to evaluate the Epidemiological, clinical and radiological features of this health problem. Methods: We reviewed 200 TBI-patients records in Ali Ibn Abi Taleb hospital of Rafsanjan during 2012-2013. A Questionnaire including age, sex, job, the cause of trauma, Glasgow coma scale (GCS), brain computed tomography (CT) scan findings and clinical symptoms for every head trauma patient; was completed. Data were analyzed by SPSS software using Chi-square test and P-value less than 0.05 was considered significant. Results: From the total of 200 patients, 73.5% were males, and 26.5% were females. The most common age group was 20-24 years. The majority of patients were students. Traffic accidents were the major cause of injuries (64.5%), and 35.5% of them were a motorcyclist. The most frequent finding of brain CT scan was skull fracture, and subdural hematoma and 25% of patient had a severe head injury. In clinical symptoms in conscious patients, headache, nausea, vomiting and vertigo was common. Conclusion: This study showed that we should pay more attention to traumatic brain injury young patients who are the most active potential forces of our society. Traffic accidents are the major reason for head injuries. Pay attention to prevention of this accident can perform an important role in decreasing of head injuries.

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Management of Cerebrospinal Fluid Leaks Involving the Temporal Bone: Report on 92 Patients

Cited by 154 publications

References 16 publications

Temporal bone encephalocele and cerebrospinal fluid fistula repair utilizing the middle cranial fossa or combined mastoid–middle cranial fossa approach

Temporal bone encephalocele and cerebrospinal fluid fistula repair utilizing the middle cranial fossa or combined mastoid–middle cranial fossa approach

Utilization of Preoperative Cerebrospinal Fluid Drain in Skull Base Surgery

Epidemiological, Clinical and Radiological Characteristics of Patients with Head Trauma

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