Our experience in the management of csf otorrhea: a transmastoid approach with middle ear cavity obliteration and a middle cranial fossa approach

Abstract

In this report, we present two cases of patients with cerebrospinal fluid (CSF) otorrhea who underwent surgical repair through either a transmastoid or middle cranial fossa approach. In our first case, a 34-year-old male after head trauma with conductive hearing loss and a House-Brackmann grade 2 facial palsy was found to have a soft tissue mass protruding through his right tympanic membrane. Radiological examination revealed a wide tegmen tympani defect. He underwent surgery via a transmastoid approach with repair of the defect and blind sac closure of the external auditory canal after middle ear cavity obliteration. Our second case involved a 50-year-old female who had developed chronic clear otorrhea following tympanostomy tube placement. Radiological evaluation revealed a tegmen tympani defect and CSF fistula. She underwent a middle cranial fossa approach in which a multilayer closure technique was performed. These two cases illustrate that the type of surgical approach for the CSF otorrhea repair depends on the location and size of the defect and hearing status. We recommend a multilayer closure to ensure proper resolution of the defect.

Management of Spontaneous Cerebrospinal Fluid Leaks in the Middle Cranial Fossa and Bone Tegmen Tympani Defect in Patients with Meningitis and Rhinorrhea

“…The choice between these approaches depends on size and location of the defect, clinical status, hearing status and surgeon's experience. Many authors recommend to perform transmastoid approach to repair the skull base defect of posterior fossa and subtemporal approach to repair tegmen defects [20]. The subtemporal extradural approach is the most commonly used in literature.…”

“…In our series, a multilayer grafts technique is used to seal the defect. Several kinds of grafts are described in literature [1,15,20]. The material of the graft can be autologous, such as abdominal fat, fascia lata, galea, cortical bone, temporalis muscle, or heterologous, such as bovine dura.…”