Transcochlear Repair of Persistent Cerebrospinal Fluid Leaks

Abstract

Continuity of air cell tracts from the petrous apex surrounding the internal auditory canal to the medial eustachian tube can provide a path for CSF rhinorrhea that is difficult to stop by conventional means. A modified transcochlear approach successfully terminated persistent leaks in four such patients.

Prevention and Management of Cerebrospinal Fluid Leak Following Vestibular Schwannoma Surgery

“…The transcochlear approach to petrous apex obliteration has also been described for recalcitrant CSF leaks, particularly those with communication between the petrous apex and peritubal cells. 8 We have not had occasion to use this technique.…”

Cerebrospinal Fluid Leak Prevention After Translabyrinthine Removal of Vestibular Schwannoma

“…In cases of highly pneumatized temporal bones, in which the CSF leak could occur through an anterior petrous apex rout, 4 we formerly obliterated the middle ear with a blind sac closure of the external auditory meatus. After analyzing the results of this technique, we found the result to be no different from that achieved with careful closure of the air cells using bone wax.…”

Does Packing the Eustachian Tube Impact Cerebrospin al Fluid Rhinorrhea Rates in Translabyrinthine Vestibular Schwannoma Resections?

“…Those undergoing ET packing are still at risk for CSF rhinorrhea through alternate air cell pathways into the ET. Using anatomic specimens and CT imaging, we and others have demonstrated the presence of peritubal air cells that can open into the ET distal to its ME orifice (19). This provides a route for CSF rhinorrhea even when both the ME and ET openings are packed.…”