Surgical Treatment for Cerebrospinal Fluid Leaks in Patients With Inner Ear Malformations

Abstract

Objective: The aim of this study is to present our technique of surgical closure in a series of patients suffering from cerebrospinal fluid (CSF) leak due to inner ear malformations. Study Design and Setting: We conducted a retrospective study in our tertiary care academic department of pediatric otolaryngology. Patients: We did include all patients who presented a CSF leak or bacterial meningitis (one episode or recurrent) related to a malformation of the inner ear. Intervention(s): Through a retro-auricular or endaural approach we performed a filling of the vestibule cavity with multiple fragments of cartilage with perichondrium introduced through the oval window, after stapedectomy until a near-complete sealing was obtained. After the surgery, all patients received a treatment with acetazolamide during 15 days. Main Outcome Measure(s): We did evaluate our technics with the recurrence of CSF leak. Results: Thirteen patients, from 1 to 14, were operated with our technics. With a follow-up of 4.4 ± 4.7 years, only one patient needed a second intervention. None had a novel episode of meningitis. We observed no complication. The leak was observed in the oval fossa in 11 cases. Conclusions: Our “minimally invasive” technique of vestibular obliteration with cartilage inserted through the oval window after stapedectomy did demonstrate its safety and reliability.