Management of Cerebrospinal Fluid Leak following Retrosigmoid Posterior Cranial Fossa Surgery


Bayazit Y. A. , Celenk F., DÜZLÜ M., Goksu N.

ORL-JOURNAL FOR OTO-RHINO-LARYNGOLOGY AND ITS RELATED SPECIALTIES, vol.71, no.6, pp.329-333, 2009 (SCI-Expanded) identifier identifier identifier

  • Publication Type: Article / Article
  • Volume: 71 Issue: 6
  • Publication Date: 2009
  • Doi Number: 10.1159/000272030
  • Journal Name: ORL-JOURNAL FOR OTO-RHINO-LARYNGOLOGY AND ITS RELATED SPECIALTIES
  • Journal Indexes: Science Citation Index Expanded (SCI-EXPANDED)
  • Page Numbers: pp.329-333
  • Keywords: Posterior cranial fossa surgery, Cerebrospinal fluid leak, Retrosigmoid approach, ACOUSTIC NEUROMA SURGERY, DRAINAGE, REMOVAL, MENINGITIS, PREVENTION, FISTULA
  • Gazi University Affiliated: Yes

Abstract

Objective: To detail our experience in the management of cerebrospinal fluid (CSF) leak following posterior cranial fossa surgery by the retrosigmoid approach. Patients and Methods: 412 patients who underwent posterior cranial fossa surgery by the retrosigmoid approach for a variety of diseases were included in the study. Results: There were 32 CSF leaks (7.7%) in the 412 patients. Of these, 16 were leaks from the incision site (50%) and 16 (50%) were CSF rhinorrheas. The CSF leaks were documented in 22 of the vestibular schwannoma surgeries (68.7%) and 10 of the vestibular nerve sectioning surgeries (31.3%). No CSF leak was seen following microvascular decompression and auditory brain stem implantation surgeries. Ten patients could be treated conservatively. Twelve patients needed the placement of a lumbar drainage. Surgical reexploration was performed in 10 patients. Conclusions: Initially, a conservative treatment should be instituted in the case of a CSF leak. If the conservative treatment fails, the placement of a lumbar drainage should be considered. Patients that do not respond to lumbar drainage require surgical reexploration. The abovementioned algorithm represents the safest and best option in the presence of a CSF leak, as confirmed by the absence of recurrences or multiple revisions in this study. Copyright (C) 2009 S. Karger AG, Basel