Middle Fossa Approach and Four Layer Repair of Cerebrospinal Fluid Otorrhea

Cerebrospinal fluid (CSF) otorrhea may occur after trauma (including iatrogenic) or spontaneously. Symptoms may be mild, such as conductive hearing loss or paradoxical rhinorrhea, but may also be life threatening such as meningitis or seizures.

Repair of such a leak is warranted, and the approach may be transmastoid or via middle fossa approach. The later enables multi-layer repair without compromise of hearing.

We report 5 recent cases in which middle fossa approach and multi-layer repair was performed. Layers included fascia, cement, vascularized muscle flap and artificial dura, along with bio-glue. After 5 day rest with continuous drainage, CSF leak was resolved in all cases. Results are stable in 6 months follow-up. Mild conductive hearing loss was found in 3/5 cases in short term follow-up. Long term audiologic follow-up is pending. No complications were reported.

Middle fossa approach with multi-layer repair is recommended for control of CSF leak. It is a safe and reliable approach with excellent long term results.