The Diagnosis and Treatment of Spontaneous Cerebral Spinal Fluid Otorrhea in the Adult

Abstract

We describe the demographic, radiologic and surgical features in adult patients with spontaneous cerebrospinal fluid otorrhea (SCSFO). Review was made of office and hospital charts of 21 patients with SCSFO and 2 patients with spontaneous CSF rhinorrhea, which were repaired successfully from 1989 to 1998. The responsible lesions for SCSFO and rhinorrhea in the adult are arachnoid granulations (AG) or villi, which are aberrantly distributed in areas of the anterior, middle and posterior cranial fossae. The ages of the 21 patients ranged from 38 to 83 years (mean 63 years), with all but one older than 50 years. The sex ratio was 14 women to 7 men; the CSF leak was right-sided in 13 and left-sided in 8 patients. Eighteen of the spontaneous CSF leaks were located in the middle cranial fossa surface of the temporal bone (TB) while 2 were on the posterior fossa border of the TB. The middle fossa leaks were managed by craniotomy and repair with fascia, whereas the posterior fossa defects were obliterated by adipose tissue inserted through an intact canal wall mastoidectomy. The most comon radiologic finding on computerized tomography was a soft tissue mass adjacent to a tegmen bone defect. The demographic, radiologic and pathologic findings in this series of 21 TB and 2 paranasal sinus spontaneous CSF leaks support the concept that the responsible lesions are AGs that are aberrantly located adjacent to pneumatized parts of the skull.

Spontaneous temporal cerebrospinal fluid leak

“…[1][2][3][4]17,19 A recent data survey shows that the average age of patients diagnosed with spontaneous temporal CSF leaks is 56.9 years, ranging from 45.7 to 63 years. 3,6,[8][9][10]17,[19][20][21][22][23][24][25][26][27][28][29][30][31][32][33][34] The patient's age in this report is, in a way, consistent with the hypothesis that spontaneous temporal CSF leak is associated with years of pulsation of intracranial content in regions of thin bones due to increased pneumatization, dehiscence or arachnoid granulations presence of the middle fossa floor. Regarding gender, most studies have noted a higher proportion of women to men in the development of spontaneous temporal CSF leaks, while others have not observed this trend.…”

“…A recent survey has showed that 64% of the spontaneous CSF leaks are associated with herniations. 3,[8][9][10]17,18,20,[22][23][24]26,29,30,32,37 In addition, the pathophysiology of spontaneous CSF leaks, due to anatomical issues, is associated to superior semicircular canal dehiscence. In patients with spontaneous temporal CSF leaks, approximately 13.1% will be associated to superior semicircular canal dehiscence.…”

Temporal Bone Skull Base Defects—The Value and Importance of Early Based Detection to Prevent Late Costly Morbidity and Mortality

“…27 28 29 OSA and IIHT are related to development of sCSF through a combination of elevated intracranial pressures, increased chronic hydrostatic forces on the dura, formation of aberrant arachnoid granulations with thinning of the skull base, and dehiscences. 10 11 12 15 16 25 26 30 In patients with cervical fat deposition (Madelung's disease), dependent postural variations can raise intracranial both venous and CSF pressures significantly. 31 In this study, patients with otogenic meningitis had a mean BMI of 28.6kg/m2 indicative of obesity, although slightly lower to BMIs in additional published series.…”

“…12 13 Affected patients are typically obese middle-aged females presenting with unilateral aural fullness, conductive hearing loss, and occasionally frank otorrhoea. 10 11 14 15 16 Biochemical analysis of ME fluid for β-trace protein (BTP) and radiological temporal bone computed tomography (CT) or thin section T2-weighted magnetic resonance imaging (MRI) aid in identifying skull base bony defects and aberrant arachnoid granulations. Patients with skull base defects may be predisposed to risks of ascending intracranial sepsis and meningitis.…”

Symptoms Underestimate the Presence of Obstructive Sleep Apnea in Patients with Spontaneous Cerebrospinal Fluid Leaks of the Temporal Bone

“…Arachnoid pits or granulations at sites where arachnoid villi are contacting the skull base have been observed in those with sCSF leaks, and leaks also occur at common sites of aberrant arachnoid granulations suggesting pressure-driven erosion through the dura and bone (37–39).…”