Middle cranial fossa approach for the repair of spontaneous cerebrospinal fluid otorrhoea using autologous bone pate.

Tegmen plate defects causing cerebrospinal fluid (CSF) leaks and brain hernias have conventionally been repaired using soft tissue grafts by a transmastoid approach. A review of the literature reveals that the results of transmastoid repairs have been less than satisfactory. We present here four patients with spontaneous CSF otorrhoea who had tegmen defects repaired using the middle cranial fossa approach. An autologous bone pate slab mixed with fibrin glue with additional temporalis fascia reinforcement was used for the repairs. All four patients had uneventful postoperative periods and have had no subsequent CSF leak (follow-up range: 1-3 years). We believe that the middle cranial fossa approach is more effective than the transmastoid approach for the repair of CSF leaks and brain hernias through tegmen plate defects. An important additional benefit is hearing preservation. We also recommend the use of bone pate along with soft tissue for the repair in order to achieve a secure seal. Bone pate can effectively seal multiple defects in the tegmen plate without any risk of migration.

[1]  S. Baredes,et al.  Spontaneous Cerebrospinal Fluid Leakage and Middle Ear Encephalocele in Seven Patients , 2000, Ear, nose, & throat journal.

[2]  S. Merchant,et al.  Neurotologic manifestations and treatment of multiple spontaneous tegmental defects. , 2000, The American journal of otology.

[3]  R. Gacek,et al.  Adult spontaneous cerebrospinal fluid otorrhea: diagnosis and management. , 1999, The American journal of otology.

[4]  R. Gacek.  The pathology of facial and vestibular neuronitis. , 1999, American Journal of Otolaryngology.

[5]  A. Batten,et al.  Use of autologous osteocyte containing bone pate for closure of tegmental defects. , 1998, The American journal of otology.

[6]  H. Sugerman,et al.  Increased intra-abdominal pressure and cardiac filling pressures in obesity-associated pseudotumor cerebri , 1997, Neurology.

[7]  S. Manolidis,et al.  Brain herniation into the middle ear and mastoid: concepts in diagnosis and surgical management. , 1997, The American journal of otology.

[8]  J. Kartush,et al.  Temporal bone encephalocele and cerebrospinal fluid leaks. , 1996, The American journal of otology.

[9]  J. May,et al.  Spontaneous cerebrospinal fluid otorrhea from defects of the temporal bone: a rare entity? , 1995, The American journal of otology.

[10]  S. Cass,et al.  Beta-2 transferrin assay in clinical management of cerebral spinal fluid and perilymphatic fluid leaks. , 1993, The Journal of otolaryngology.

[11]  F. Chu,et al.  Spontaneous Posterior Fossa Cerebrospinal Fluid Leak , 1993, Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery.

[12]  N. Cohen,et al.  Spontaneous temporal bone cerebrospinal fluid leak. , 1992, The American journal of otology.

[13]  R. Ruby,et al.  Recurrent meningitis secondary to perilymph fistula in young children. , 1990, The Journal of otolaryngology.

[14]  D. B. Mitchell,et al.  Recurrent meningitis in children due to inner ear abnormalities , 1989, The Journal of Laryngology & Otology.

[15]  R. Wiet,et al.  Brain herniation and space‐occupying lesions eroding the tegmen tympani , 1987, The Laryngoscope.

[16]  J. Farmer,et al.  Spontaneous csf otorrhea from tegmen and posterior fossa defects , 1986, The Laryngoscope.

[17]  L. Feenstra,et al.  Surgical treatment of brain herniation into the middle ear and mastoid. , 1985, The American journal of otology.

[18]  W. Y. Adkins,et al.  Mini‐craniotomy for management of csf otorrhea from tegmen defects. , 1983, The Laryngoscope.

[19]  M. Graham.  Surgical management of dural and temporal lobe herniation into the radical mastoid cavity , 1982, The Laryngoscope.

[20]  G. Hicks,et al.  CEREBROSPINAL FLUID OTORRHEA , 1980, The Laryngoscope.

[21]  M. Glasscock,et al.  Surgical management of brain tissue herniation into the middle ear and mastoid , 1979, The Laryngoscope.

[22]  H. Yonas,et al.  Acquired middle cranial fossa fistulas: normal pressure and nontraumatic in origin. , 1979, Neurosurgery.

[23]  K. Irjala,et al.  Identification of CSF leakage by immunofixation. , 1979, Archives of otolaryngology.

[24]  Dedo Gg,et al.  Endaural encephalocele and cerebrospinal fluid otorrhea. , 1970 .

[25]  R. Ruggles,et al.  Surgical repair of dural herniation into the mastoid bowl. , 1969, Archives of otolaryngology.

[26]  C. Thulin,et al.  Lethal Intracranial Complications Following Inflation in the External Auditory Canal in Treatment of Serous Otitis Media and Due to Defects in the Petrous Bone , 1965 .

[27]  A. Ommaya.  Cerebrospinal fluid rhinorrhea , 1964, Neurology.