Management options for cerebrospinal fluid leak after vestibular schwannoma surgery and introduction of an innovative treatment.
OBJECTIVE
To review the management of cerebrospinal fluid leak after vestibular schwannoma removal reported in the literature and to present a novel approach to management of recalcitrant cases.


METHODS
MEDLINE and PubMed literature search using the terms "cerebrospinal fluid leak" or "cerebrospinal fluid fistula" and "acoustic neuroma" or "vestibular schwannoma" covering the period from 1985 to present in English. A review of bibliographies of these studies was also performed.


METHODS
Criteria for inclusion in this meta-analysis consisted of the availability of extractable data from studies presenting a defined group of patients who had undergone primary vestibular schwannoma removal and for whom the presence and absence of cerebrospinal fluid leakage was reported. Studies reporting combined approaches were excluded. No duplications of patient populations were included. Twenty-five studies met the inclusion criteria.


METHODS
Quality of the studies was determined by the design of each study and the ability to combine the data with the results of other studies. All of the studies were biased by their retrospective, nonrandomized nature.


RESULTS
Significance (p < 0.05) was determined using the chi test.


CONCLUSIONS
Incisional cerebrospinal fluid leakage responded well to local management and lumbar drainage. Rhinorrhea often necessitated surgical intervention. No specific reoperation techniques correlated exclusively with better reoperation outcomes. The transaural/transnasal approach presents an alternative for surgical management of cerebrospinal fluid rhinorrhea.
Selesnick
Samuel H
SH
Department of Otorhinolaryngology, Weill College of Medicine of Cornell University, New York, New York 10021, USA. shselen@mail.med.cornell.edu
Liu
Jeffrey C
JC
Jen
Albert
A
Carew
John F
JF
D000328:Adult; D000368:Aged; D002558:Cerebrospinal Fluid Otorrhea / Q000209:etiology* / Q000628:therapy*; D016009:Chi-Square Distribution; D004322:Drainage; D005064:Eustachian Tube / Q000601:surgery; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009464:Neuroma, Acoustic / Q000601:surgery*; D013506:Otologic Surgical Procedures / Q000009:adverse effects*; D011183:Postoperative Complications / Q000628:therapy*