Spontaneous osteodural defects of the temporal bone: diagnosis and management of 12 cases.
OBJECTIVE
The objectives of the study were to describe the clinical presentation, diagnostic process, surgical treatment, and outcome of patients with spontaneous dural defect of temporal bone and to explore the possible contribution of idiopathic intracranial hypertension.


METHODS
Medical records of consecutive patients with spontaneous defects of the temporal bone were reviewed. Clinical presentation, diagnostic process, exploration of benign intracranial hypertension, surgical management, and outcome of patients are presented.


RESULTS
Six of the 12 patients presenting with spontaneous cerebrospinal fluid otorrhea were women. Ages ranged from 38 to 76 years. Seven patients presented with meningitis. The location and the extent of the occurring defect were detected by computed tomography in all cases. Radiologic signs of empty sella syndrome, indicator of benign intracranial hypertension, were revealed in 3 cases using magnetic resonance imaging. Six tegmen defects were repaired using a middle fossa approach without recurrence. Four patients received the combined approach. All patients had complete resolution of the cerebrospinal fluid leak, although 2 cases developed adverse effects attributable to surgical procedure.


CONCLUSIONS
The diagnosis of spontaneous cerebrospinal fluid otorrhea requires clinical suspicion in the setting of meningitis and persistent serous otitis media. High-resolution computed tomography can confirm the diagnosis. The authors' findings advocate the multilayered closure technique through a middle fossa approach.
Markou
Konstantinos
K
Department of Otolaryngology and Skull Base Surgery, Pellegrin University Hospital, University of Victor Segalen Bordeaux 2, Bordeaux, France.
Goudakos
John
J
Franco-Vidal
Valerie
V
Vergnolles
Vincent
V
Vignes
Jean-Rodolph
JR
Darrouzet
Vincent
V
D000328:Adult; D000368:Aged; D001847:Bone Diseases / Q000175:diagnosis* / Q000209:etiology / Q000601:surgery*; D002558:Cerebrospinal Fluid Otorrhea / Q000175:diagnosis* / Q000209:etiology / Q000601:surgery*; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D008297:Male; D008581:Meningitis / Q000175:diagnosis; D008875:Middle Aged; D010034:Otitis Media with Effusion / Q000175:diagnosis; D011559:Pseudotumor Cerebri / Q000150:complications*; D012189:Retrospective Studies; D013536:Suture Techniques; D013701:Temporal Bone / Q000000981:diagnostic imaging / Q000601:surgery; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome