Management of Spontaneous Cerebrospinal Fluid Otorrhea

Kutz, Joe Walter; Husain, Inna Athar; Isaacson, Brandon; Roland, Peter S.

doi:10.1097/mlg.0b013e318182f833

Cited by 134 publications

(109 citation statements)

References 15 publications

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“…4,8,12,16 This sequence of events results in effusions in the middle ear and mastoid air cells that can manifest as CSF fistulas, through a disrupted tympanic membrane or via the eustachian tube. [1][2][3]5,11,12,15 Given that intracranial hypertension has been implicated as a significant factor in temporal encephalocele formation, 7,[10][11][12]15 we hoped to clarify this correlation by reviewing a series of tegmen defects repaired surgically and the associated ICP measurements in these patients. Additionally, we aimed to determine the rate of and indications for VP shunt placement.…”

mentioning

confidence: 99%

Surgical management of temporal meningoencephaloceles, cerebrospinal fluid leaks, and intracranial hypertension: treatment paradigm and outcomes

Kenning¹,

Willcox²,

Artz³

et al. 2012

FOC

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Object Thinning of the tegmen tympani and mastoideum components of the temporal bone may predispose to the development of meningoencephaloceles and spontaneous CSF leaks. Surgical repair of these bony defects and associated meningoencephaloceles aids in the prevention of progression and meningitis. Intracranial hypertension may be a contributing factor to this disorder and must be fully evaluated and treated when present. The purpose of this study was to establish a treatment paradigm for tegmen defects and elucidate causative factors. Methods The authors conducted a retrospective review of 23 patients undergoing a combined mastoidectomy and middle cranial fossa craniotomy for the treatment of a tegmen defect. Results The average body mass index (BMI) among all patients was 33.2 ± 7.2 kg/m2. Sixty-five percent of the patients (15 of 23) were obese (BMI > 30 kg/m2). Preoperative intracranial pressures (ICPs) averaged 21.8 ± 6.0 cm H2O, with 10 patients (43%) demonstrating an ICP > 20 cm H2O. Twenty-two patients (96%) had associated encephaloceles. Five patients underwent postoperative ventriculoperitoneal shunting. Twenty-two CSF leaks (96%) were successfully repaired at the first attempt (average follow-up 10.4 months). Conclusions Among all etiologies for CSF leaks, those occurring spontaneously have the highest rate of recurrence. The surgical treatment of temporal bone defects, as well as the recognition and treatment of accompanying intracranial hypertension, provides the greatest success rate in preventing recurrence. After tegmen dehiscence repair, ventriculoperitoneal shunting should be considered for patients with any combination of the following high-risk factors for recurrence: spontaneous CSF leak not caused by another predisposing condition (that is, trauma, chronic infections, or prior surgery), high-volume leaks, CSF opening pressure > 20 cm H2O, BMI > 30 kg/m2, preoperative imaging demonstrating additional cranial base cortical defects (that is, contralateral tegmen or anterior cranial base) and/or an empty sella turcica, and any history of an event that leads to inflammation of the arachnoid granulations and impairment of CSF absorption (that is, meningitis, intracranial hemorrhage, significant closed head injury, and so forth).

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mentioning

confidence: 99%

Surgical management of temporal meningoencephaloceles, cerebrospinal fluid leaks, and intracranial hypertension: treatment paradigm and outcomes

Kenning¹,

Willcox²,

Artz³

et al. 2012

FOC

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“…Numerosos estudios muestran una importante asociación entre las fístulas espontáneas de LCR y el sexo femenino 3,6,7,9,17 . Suelen ser mujeres de edad media o mayores, generalmente con sobrepeso, y que refieren una historia progresiva de pérdida de audición con sensación de plenitud en el oído, sugestivo de otitis serosa persistente 6 .…”

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“…Suelen ser mujeres de edad media o mayores, generalmente con sobrepeso, y que refieren una historia progresiva de pérdida de audición con sensación de plenitud en el oído, sugestivo de otitis serosa persistente 6 . En muchos casos, es la salida de un líquido claro y constante a través de una miringotomía o la inserción de un tubo de timpanostomía lo que da el diagnóstico 6,9 . La meningitis es la forma de presentación en el 18-25% de los casos según fuentes de la literatura, siendo menos frecuente que en los niños.…”

Section: Discussionunclassified

“…Los defectos óseos se localizan mayoritariamente en el tegmen timpani y en el tegmen mastoideo 3,6,9,17 , siendo más raros en la pared posterior del hueso temporal, donde el hueso cortical es más grueso y no existen dehiscencias fisiológicas, como en la fosa craneal media. De hecho, la presencia de erosiones en fosa posterior es muy sugerente de la existencia de granulaciones aracnoideas aberrantes, que si bien no suelen tener traducción clínica, deben hacer sospechar una fístula de LCR cuando se acompañan de opacificación de las celdillas mastoideas adyacentes 10 .…”

Section: ; 22: 150-156unclassified

“…El porcentaje de éxito de un cierre multicapa con materiales autólogos llega al 81%, frente al 50% si se usan sólo materiales artificiales. Entre ellos, cabría destacar la cera de hueso, Gelfoam, Oxycel, Duragen, la pasta de hueso autólogo 6,13 o los más recientes cementos de hueso 9 . La combinación de ambos tipos de materiales aumenta la probabilidad de éxito al 100% 18 .…”

Section: ; 22: 150-156unclassified

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Otolicuorrea espontánea en el adulto: Presentación de dos casos y revisión de la literatura

et al. 2011

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ResumenIntroducción. Las fístulas espontáneas de LCR no son una entidad frecuente y pueden ser infradiagnosticadas en el adulto. Para algunos autores, debe sospecharse esta patología en cualquier paciente mayor de 50 años con episodios de otitis serosas recurrentes y ausencia de antecedentes otológicos. La meningitis es su complicación más grave, por lo que es prioritario un diagnóstico precoz y certero.Objetivo. Presentar dos casos clínicos atendidos en nuestro servicio y revisar la literatura científica existente al respecto.Conclusión El tratamiento de estas fístulas atraumá-ticas es eminentemente quirúrgico, pudiendo emplear la craneotomía de fosa media o la vía transmastoidea. En el sellado debe emplearse una técnica multicapa, combinando materiales autólogos y artificiales para conseguir mejores resultados.PALABRAS CLAVE: Otolicuorrea espontánea. Fístula de LCR. Otitis serosa media. Defectos hueso temporal. Adult spontaneous cerebrospinal fluid otorrhea. Report of two cases and review of the literature SummaryIntroduction. Spontaneous cerebrospinal fluid otorrhea is a relatively rare entity and can be easily missed in adults. Every adult older than 50 years with a negative history of otologic disease who has recurrent serous otitis media should be evaluated for this pathology. Meningitis is the most serious complication, so there is no doubt that the condition needs immediate attention and correction.Objective. We present two patients who were diagnosed with spontaneous CSF otorrhea and make a review of what is reported about this topic. Conclusion.Surgical repair is mandatory to seal these nontraumatic CSF leaks. There are two main surgical approaches, the middle fossa craniotomy and the transmastoid approach. A multilayered closure technique in which autologous and artificial materials are combined is considered to result in the highest rate of success.

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A novel method for autograft placement during tegmen repair: The suture “pull‐through” technique

et al. 2014

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Management of Spontaneous Cerebrospinal Fluid Otorrhea

Cited by 134 publications

References 15 publications

Surgical management of temporal meningoencephaloceles, cerebrospinal fluid leaks, and intracranial hypertension: treatment paradigm and outcomes

Surgical management of temporal meningoencephaloceles, cerebrospinal fluid leaks, and intracranial hypertension: treatment paradigm and outcomes

Otolicuorrea espontánea en el adulto: Presentación de dos casos y revisión de la literatura

A novel method for autograft placement during tegmen repair: The suture “pull‐through” technique

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