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An algorithm for the surgical approach to spontaneous temporal bone CSF leak.
- Source :
-
American journal of otolaryngology [Am J Otolaryngol] 2024 Sep-Oct; Vol. 45 (5), pp. 104411. Date of Electronic Publication: 2024 Jul 23. - Publication Year :
- 2024
-
Abstract
- Objective: To suggest a comprehensive algorithm for the surgical approach for correcting of sources of temporal bone CSF leaks.<br />Methods: A case series for patients operated in a single academic tertiary referral center between 2011 and 4.2022. Included in the study were 46 patients, 5 of whom had a bilateral problem, resulting in 51 pathologic temporal bones. The presentation was an active CSF leak (38 patients) or bacterial otogenic meningitis (8 patients). Follow up ranged from 8 months to 5 years.<br />Results: Of the 42 ears operated via the default middle fossa approach, 37 were successful (88 %) in controlling CSF leak. None had intracranial complications or sensorineural hearing loss. Location, number and size of the defects, hearing status, associated superior semicircular canal dehiscence, additional intra-temporal or intra-cranial pathologies may indicate a transmastoid approach. Of the six ears that had a canal wall up mastoidectomy as a primary procedure, one required revision due to ongoing CSF leak. Five revision cases and three primary cases were effectively sealed with a subtotal petrosectomy and obliteration. One was lost to follow-up. Hearing was reconstructed with bone-anchored hearing implants in 6 out of these 8 ears.<br />Conclusions: The middle fossa approach could be used as a default approach for sealing TD. There are a number of indications for transmastoid approaches in both primary and revision cases. Obliteration of the ear was used in all revision cases. The suggested algorithm can help in planning surgery for temporal bone CSF leaks or a history of otogenic meningitis.<br />Competing Interests: Declaration of competing interest None.<br /> (Copyright © 2024 Elsevier Inc. All rights reserved.)
- Subjects :
- Humans
Male
Female
Middle Aged
Adult
Treatment Outcome
Aged
Follow-Up Studies
Young Adult
Meningitis, Bacterial surgery
Mastoidectomy methods
Retrospective Studies
Adolescent
Otologic Surgical Procedures methods
Temporal Bone surgery
Algorithms
Cerebrospinal Fluid Leak surgery
Cerebrospinal Fluid Leak etiology
Subjects
Details
- Language :
- English
- ISSN :
- 1532-818X
- Volume :
- 45
- Issue :
- 5
- Database :
- MEDLINE
- Journal :
- American journal of otolaryngology
- Publication Type :
- Academic Journal
- Accession number :
- 39059170
- Full Text :
- https://doi.org/10.1016/j.amjoto.2024.104411