Surgical outcomes in the treatment of temporal bone cerebrospinal fluid leak: A systematic review

Auris Nasus Larynx. 2018 Oct;45(5):903-910. doi: 10.1016/j.anl.2018.03.006. Epub 2018 Apr 8.

Abstract

Objective: Temporal bone CSF leak represents a rare condition that may be associated to some particular symptoms as hearing loss, otorrhea and tinnitus. In the opinion of many authors a surgical treatment is mandatory to avoid serious consequences as meningitis. Middle cranial fossa (MCF), transmastoid (TM) and combined approaches are all described to manage this condition. The objective of this paper was firstly to analyze the overall outcomes of this surgery. Our second aim was to make a comparison between different surgical modalities on the basis of their rate of success and complications.

Methods: A search thorough Ovid MEDLINE was organized in January 2017 to enroll all eligible articles. A statistical analysis of the obtained data was performed.

Results: Thirtythree studies comprising a total of 873 procedures were included. The overall rate of success resulted 95.6% (94.1–96.8). The rate of major complications analyzed for 818 procedures was 3.4% (2.3–4.8). Subgroups analysis showed a success rate of 97.1% (90.7–99.5) for TM approach. A success rate of 94.1% (89.1–97.3) was calculated for MCF approach. Combined procedure (TM + MCF) showed a success rate of 97.9% (92.9–99.7).

Conclusion: The results of our review showed as the surgical treatment for CSF leak of temporal bone origin represents a safe option with high rate of success. Moreover our statistical data suggested that no significant differences are present in terms of outcomes between the analyzed surgical approaches.

MeSH terms

  • Cerebrospinal Fluid Leak / etiology
  • Cerebrospinal Fluid Leak / surgery*
  • Cholesteatoma / complications
  • Chronic Disease
  • Cranial Irradiation / adverse effects
  • Humans
  • Otitis Media / complications
  • Otorhinolaryngologic Surgical Procedures / methods*
  • Skull Base Neoplasms / complications
  • Temporal Bone / injuries
  • Temporal Bone / surgery*
  • Treatment Outcome