title: Spontaneous cerebrospinal fluid otorrhea from a tegmen defect: transmastoid repair with minicraniotomy.
abstract: Spontaneous cerebrospinal fluid (CSF) otorrhea is a rare condition that presents in 2 clinical categories. In congenital labyrinthine malformations, it leads to bouts of meningitis in a hearing-impaired child. In the adult age group, a spontaneous CSF leak almost always results from a dural and bony defect in the tegmen area. Possible pathogenic mechanisms include progressive sagging and rupture of dura through a congenital tegmen dehiscence and progressive bone erosion by aberrant arachnoid granulations. These patients usually present with a middle ear effusion, resulting in clear discharge after myringotomy with tube insertion. Based on 4 patients with a CSF leak from a tegmen defect, this report reviews the clinical findings and diagnostic approach. The surgical management by a 5-layer closure using a transmastoid approach with minicraniotomy is outlined. This procedure offers a relatively simple and reliable method for repair without the inherent risks of a middle fossa craniotomy.
authors.affiliation: Department of Otorhinolaryngology-Head and Neck Surgery, AZ Sint Jan Hospital, Bruges, Belgium.
authors.forename: R
authors.initials: R
authors.lastname: Kuhweide
authors.forename: J W
authors.initials: JW
authors.lastname: Casselman
mesh_terms: D017668:Age of Onset; D000368:Aged; D002558:Cerebrospinal Fluid Otorrhea / Q000209:etiology* / Q000601:surgery*; D003399:Craniotomy / Q000379:methods*; D004677:Encephalocele / Q000150:complications*; D006801:Humans; D008297:Male; D008416:Mastoid / Q000601:surgery; D008588:Meningocele / Q000150:complications*; D008875:Middle Aged; D010034:Otitis Media with Effusion / Q000150:complications*; D012886:Skull / Q000002:abnormalities* / Q000000981:diagnostic imaging; D014057:Tomography, X-Ray Computed