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Ann Otol Rhinol Laryngol 2021 Apr 9:34894211007242. Epub 2021 Apr 9.

Bobby R. Alford Department of Otolaryngology-Head and Neck Surgery, Baylor College of Medicine, Houston, TX, USA.

Objectives: To report a recalcitrant spontaneous cerebrospinal fluid (CSF) fistula arising from multiple, anatomically-linked lateral skull base defects, and to review the available literature to determine optimal techniques for operative repair of congenital CSF fistulae.

Methods: A patient with recurrent episodes of otologic meningitis was found to have a patent tympanomeningeal fissure, also known as a Hyrtl's fissure, and internal auditory canal (IAC) diverticulum that communicated with the jugular bulb. A systematic review of the literature characterized all reports of spontaneous congenital perilabyrinthine CSF leaks, and all cases of Hyrtl's fissures. Read More

Otol Neurotol 2021 07;42(6):938-944

Department of Neurological Surgery, Rush University Medical Center, Chicago, Illinois.

Objective: To characterize the radiologic findings of petrous apex cephalocele (PAC) in a patient cohort, and report the surgical management for three symptomatic PAC patients and cerebrospinal fluid (CSF) leak via the middle cranial fossa approach.

Study Design: Retrospective case series.

Setting: Academic center. Read More

Otol Neurotol 2021 03;42(3):424-430

Department of Head and Neck Surgery, Kaiser Permanente San Diego, California.

Objective: Describe audiometric outcomes following transmastoid and middle cranial fossa (MCF) approaches for repair of cerebrospinal fluid (CSF) otorhinorrhea.

Study Design: Retrospective case series.

Setting: Tertiary skull base referral center. Read More

Ann Otol Rhinol Laryngol 2021 Jan 30;130(1):38-46. Epub 2020 Jun 30.

Division of Otolaryngology-Head and Neck Surgery, University of Utah, Salt Lake City, UT, USA.

Objective: Describe the outcomes of treatment for patients with cholesteatomas that are medially invasive to the otic capsule, petrous apex, and/or skull base.

Study Design: Retrospective case series.

Setting: Two tertiary care academic centers. Read More

Am J Rhinol Allergy 2021 Jan 19;35(1):36-43. Epub 2020 Jun 19.

Department of Ophthalmology, Emory University School of Medicine, Atlanta, Georgia.

Background: The association between spontaneous skull base cerebrospinal fluid (CSF) leaks and idiopathic intracranial hypertension (IIH) has been suggested, but its significance remains unclear.

Objective: To estimate the prevalence of IIH in spontaneous skull base CSF leak patients.

Methods: Systematic collection of demographics, neuro-ophthalmic and magnetic resonance imaging evaluation of spontaneous skull base CSF leak patients seen pre- and post-leak repair in one neuro-ophthalmology service. Read More

Neurosurg Focus 2019 11;47(5):E10

Objective: Skull fractures are common after blunt pediatric head trauma. CSF leaks are a rare but serious complication of skull fractures; however, little evidence exists on the risk of developing a CSF leak following skull fracture in the pediatric population. In this epidemiological study, the authors investigated the risk factors of CSF leaks and their impact on pediatric skull fracture outcomes. Read More

World Neurosurg 2020 Mar 8;135:e1-e11. Epub 2019 Oct 8.

Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA.

Background: Cerebrospinal fluid (CSF) leaks have been historically difficult to diagnose and treat because their cause can widely vary. There are insufficient diagnostic predictors and no clinically accepted standards for their treatment. This large institutional study reports on the diagnosis, management, and outcomes of patients presenting with CSF leak over 10 years and aims to identify potential comorbidities and risk factors for primary and recurrent leaks. Read More

World Neurosurg 2020 Jan 27;133:e683-e689. Epub 2019 Sep 27.

Department of Neurosurgery, NorthShore University Health System, Evanston, Illinois, USA. Electronic address:

Objective: The middle fossa craniotomy for tegmen defect repair provides wide access. This approach often requires temporal lobe manipulation, lumbar drain placement, and longer recovery. We describe a keyhole middle fossa approach with a simple titanium skull base repair that allows for wide access with no temporal lobe manipulation and does not require lumbar drain placement, which results in a dramatic reduction in hospital length of stay. Read More

Curr Opin Otolaryngol Head Neck Surg 2019 Oct;27(5):344-348

Department of Otorhinolaryngology - Head and Neck Surgery, University of Pennsylvania, Philadelphia, Pennsylvania, USA.

Purpose Of Review: To review the presenting signs and symptoms of spontaneous cerebrospinal fluid (CSF) leaks of the lateral skull base.

Recent Findings: Research continues to demonstrate that CSF leaks from the lateral skull base are insidious, and present with subtle signs and symptoms. Patients commonly present with symptoms of aural fullness, middle ear effusion, and otorrhea following tympanostomy tube insertion that can be confused for chronic otitis media. Read More

J Int Adv Otol 2019 Aug;15(2):313-316

Department of Otorhinolaryngology, Head and Neck Surgery, Ain-Shams University, Cairo, Egypt.

Cerebrospinal fluid (CSF) rhinorrhea is not an uncommon condition, and it may lead to recurrent attacks of meningitis. The detection of the leakage site is an essential part of the investigations performed for the patient. In some cases, an anterior skull base site cannot be detected despite continuous leakage. Read More

Asian J Neurosurg 2019 Apr-Jun;14(2):473-478

Department of Neurosurgery, Faculty of Medicine, Fayoum University, Fayoum, Egypt.

Background: Cerebrospinal fluid (CSF) leak is an unfortunate, yet well-recognized complication of skull base fractures, skull base surgeries, and variety of spinal procedures. Continuous lumbar drainage (CLD) of leaking CSF has shown a high success rate with minimal morbidities in handling CSF leak in these patients. Therefore, we conducted this study to illustrate the efficacy of CLD as a prophylactic and therapeutic method for CSF leakage with the assessment of clinical outcome and early postoperative sequel. Read More

Rinsho Shinkeigaku 2019 Apr 30;59(4):205-210. Epub 2019 Mar 30.

Department of Neurology, Japan Community Healthcare Organization Kyushu Hospital.

A 76-year-old man, who had undergone surgery for esophageal cancer in 2010, presented to our hospital in April 2017 complaining of prolonged slight fever, loss of appetite, and dysphagia. Initial evaluation revealed a paralyzed left vocal cord, slight muscle weakness of the extremities, left facial paralysis, hoarseness, left sternocleidomastoid and trapezius muscle weakness, tongue deviation to the left, and left hypacusia-suggesting a diagnosis of Garcin's syndrome. Laboratory tests revealed increased white blood cells and C-reactive protein. Read More

Acta Otolaryngol 2019 May 12;139(5):421-424. Epub 2019 Mar 12.

d "Sackler" Faculty of Medicine, Department of Otolaryngology, Head & Neck, and Maxillofacial Surgery , Tel Aviv "Sourasky" Medical Center, Tel Aviv University , Tel Aviv , Israel.

Background: Marfan syndrome (MFS) is a genetic disorder affecting connective tissue. The composition of the dura can change. Consequently, lumbo-sacral dural herniations and cerebrospinal fluid (CSF) leaks are encountered, however, they have yet to been described in the temporal bone. Read More

J Neurol Surg B Skull Base 2018 Aug 10;79(4):330-334. Epub 2017 Nov 10.

Department of Neurosurgery, University of Tennessee Health Science Center, Memphis, Tennessee, United States.

 Primary closure of posterior fossa dura can be challenging, and postoperative cerebrospinal fluid (CSF) leaks continue to represent a common complication of the retrosigmoid approach. We describe a simple technique to allow for primary closure of the dura following retrosigmoid approaches. The incidence of CSF leaks using this method is reported. Read More

Diagn Interv Imaging 2019 Jan 15;100(1):3-15. Epub 2018 Jun 15.

Department of Radiodiagnosis, Pushpagiri Institute of Medical Sciences and Research Centre, Thiruvalla, 689101 Kerala, India.

Cerebrospinal fluid (CSF) leaks are extracranial egress of CSF into the adjacent paranasal sinus or tympanomastoid cavity due to an osteodural defect involving skull base. It can be due to a multitude of causes including accidental or iatrogenic trauma, congenital malformations and spontaneous leaks. Accurate localization of the site of the leak, underlying causes and appropriate therapy is necessary to avoid associated complications. Read More

World Neurosurg 2018 Oct 2;118:e10-e17. Epub 2018 Jun 2.

Division of Neurological Surgery, University of Missouri School of Medicine, Columbia, Missouri, USA. Electronic address:

Background: Temporal bone tegmen defects may be associated with cerebrospinal fluid (CSF) otorrhea. A variety of techniques have been used for repair. We report our experience with skull base reconstruction for tegmen defects using either autologous or alloplastic grafts. Read More

Neurosurgery 2019 06;84(6):1290-1295

Department of Otolaryngology, Head and Neck Surgery, Rush University Medical Center, Chicago, Illinois.

Background: Temporal bone dehiscence (TBD) often results in leakage of cerebrospinal fluid (CSF) and/or encephalocele. TBD can also occur over the superior semicircular canal, causing debilitating vertigo. Both can be repaired surgically, but traditional treatment is focused only on one pathology, not both. Read More

J Neurosci Rural Pract 2018 Apr-Jun;9(2):226-231

Department of Medicine, AIIMS, Jodhpur, Rajasthan, India.

Objective: The aim of this study was to evaluate clinico-radiological profile and outcome of pediatric traumatic brain injury (TBI).

Design: Prospective observational study.

Setting: Intensive Care Unit, ward and OPD of Pediatrics, Dr. Read More

Otolaryngol Head Neck Surg 2018 09 24;159(3):543-552. Epub 2018 Apr 24.

4 Department of Otolaryngology-Head and Neck Surgery, University of Cincinnati, Cincinnati, Ohio, USA.

Objectives (1) Compare lateral skull base (LSB) height/thickness in patients with spontaneous cerebrospinal fluid otorrhea (CSF), superior canal dehiscence (SCD), acoustic neuromas (AN), and otosclerosis (OTO). (2) Perform correlations between age, body mass index (BMI), sex, and LSB height/thickness. Study Design Case series with chart review. Read More

Laryngoscope 2018 09 18;128(9):2170-2177. Epub 2018 Apr 18.

Department of Otolaryngology, University of Texas Southwestern Medical Center, Dallas, Texas, U.S.A.

Objectives/hypothesis: To describe the presentation, surgical findings, and outcomes in patients with spontaneous temporal bone cerebrospinal fluid (CSF) fistulas and encephaloceles.

Study Design: Retrospective chart review.

Methods: A retrospective chart review of patients treated for a spontaneous temporal bone CSF fistula and/or encephalocele over a 10-year period was performed. Read More

Auris Nasus Larynx 2018 10 8;45(5):903-910. Epub 2018 Apr 8.

Otolaryngology Unit, Department of Clinical and Molecular Sciences, Polytechnic University of Marche, Ancona, Italy.

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. Read More

Neurosurg Focus 2018 04;44(4):E10

2Department of Neurosurgery, Neurological Institute, and.

OBJECTIVE Despite the advances in skull base techniques, large petroclival meningiomas (PCMs) still pose a challenge to neurosurgeons. The authors' objective of this study was to describe a pretemporal trans-Meckel's cave transtentorial approach for large PCMs and to report the surgical outcomes. METHODS From 2014 to 2017, patients harboring large PCMs (> 3 cm) and undergoing their first resection via this procedure at the authors' institute were included. Read More

Int J Crit Illn Inj Sci 2017 Oct-Dec;7(4):231-235

Department of Otorhinolaryngology, Head and Neck Surgery, Jos University Teaching Hospital, Jos, Plateau State, Nigeria.

Background: Otorhinolaryngological injuries following head trauma may be missed, overlooked, or forgotten in the acute phase resulting in worsened management outcomes. This study aims to report the epidemiology, clinical presentations, management, and outcomes of otorhinolaryngological injuries in head trauma with a view to creating awareness for early recognition and prompt treatment.

Patients And Methods: Head injured patients consecutively presenting over a 5-year period were prospectively studied for age, gender, otorhinolaryngological presentations, interventions, and outcome of interventions. Read More

J Int Adv Otol 2017 Dec 14;13(3):430-433. Epub 2017 Dec 14.

Department of Otolaryngology Head and Neck Surgery, İstanbul University School of Medicine, İstanbul, Turkey.

Spontaneous cerebrospinal fluid (CSF) otorrhea frequently occurs without temporal bone trauma, fracture, surgery, or any identifiable causes. It is usually associated with tegmen tympani defects of the temporal bone in adults. The congenital origin theory and the arachnoid granulation theory have been accepted to explain the tegmen tympani defect. Read More

Turk Neurosurg 2020 ;30(3):454-457

Dokuz Eylul University, Department of Ear Nose Throat, Izmir, Turkey.

In this report, we present two cases of patients with cerebrospinal fluid (CSF) otorrhea who underwent surgical repair through either a transmastoid or middle cranial fossa approach. In our first case, a 34-year-old male after head trauma with conductive hearing loss and a House-Brackmann grade 2 facial palsy was found to have a soft tissue mass protruding through his right tympanic membrane. Radiological examination revealed a wide tegmen tympani defect. Read More

World Neurosurg 2017 Dec 1;108:157-162. Epub 2017 Sep 1.

Department of Neurosurgery, Tokai University School of Medicine, Kanagawa, Japan.

Background: Skull base reconstruction is an essential technique for repairing cerebrospinal fluid (CSF) leakage. A reliable method for middle cranial fossa (MCF) reconstruction with minimal invasiveness has not been reported. An initial case of endoscopic MCF reconstruction with a subtemporal keyhole is described. Read More

J Neurosurg 2018 06 11;128(6):1880-1884. Epub 2017 Aug 11.

3Neurosurgery, Temple University School of Medicine, Philadelphia, Pennsylvania.

OBJECTIVE Temporal lobe encephaloceles and cerebrospinal fluid otorrhea from temporal bone defects that involve the tegmen tympani and mastoideum are generally repaired using middle fossa craniotomy, mastoidectomy, or combined approaches. Standard middle fossa craniotomy exposes patients to dural retraction, which can lead to postoperative neurological complications. Endoscopic and minimally invasive techniques have been used in other surgeries to minimize brain retraction, and so these methods were applied to repair the lateral skull base. Read More

Otolaryngol Head Neck Surg 2017 05 7;156(5):924-932. Epub 2017 Feb 7.

2 Department of Otolaryngology-Head and Neck Surgery, University of Cincinnati (UC) College of Medicine and Neurosensory Disorders Center at UC Gardner Neuroscience Institute, Cincinnati, Ohio, USA.

Outcome Objectives To (1) explore audiometric outcomes following use of a combined transmastoid/middle cranial fossa (TM-MCF) approach in the treatment of spontaneous cerebrospinal fluid (CSF) otorrhea and (2) determine the influence of dehiscence location and reconstructive methodology on audiometric outcomes. Study Design Case series with chart review. Setting Tertiary care center. Read More

No Shinkei Geka 2016 Dec;44(12):1053-1057

Department of Neurosurgery, Atami Tokoro Memorial Hospital.

Spontaneous cerebrospinal fluid(CSF)otorrhea is less common than CSF leakage caused by trauma, and rarely occurs in adults. We report an adult case of CSF otorrhea. A 71-year-old woman with no traumatic or otologic history was hospitalized due to bacterial meningitis. Read More