title: Management of CSF leakage after microsurgery for vestibular schwannoma via the middle cranial fossa approach.
abstract: Microsurgery is one of the primary current standard options for the treatment of vestibular schwannoma (VS). Especially the middle cranial fossa (MCF) approach is a safe and efficacious technique for the preservation of hearing and facial nerve function in small VS. Postoperative complications are rare, although a leakage of cerebrospinal fluid (CSF) is common. The aim of this study was to analyze postoperative CSF leaks and to describe strategies for postoperative treatment. Between October 2005 and May 2012, 148 patients suffering from VS and selected for microsurgery via the MCF approach were treated in our department. Postoperative CSF leakage occurred in 19 patients. We found a leakage via the Eustachian tube into the nasopharynx in 18 patients and one case of incisional leakage. In 13 cases leaking stopped within 5 days by conservative management including bed rest and intravenous (i.v) antibiotics. Five patients needed lumbar drainage (LD) and only two patients had to undergo revision surgery to seal and pack the mastoid. Analyzed risk factors were age, gender, tumor size and pneumatization of the mastoid. Only the latter showed a significant influence on CSF leakage. We could demonstrate that a stepwise strategy is needed for successful treatment of CSF leaks.
authors.affiliation: Department of Oto-Rhino-Laryngology, Plastic, Aesthetic and Reconstructive Head and Neck Surgery, University Hospital of Wuerzburg, Josef-Schneider-Strasse 11, 97080, Würzburg, Germany. scheich_m@ukw.de.
authors.forename: Matthias
authors.initials: M
authors.lastname: Scheich
authors.affiliation: Department of Oto-Rhino-Laryngology, Plastic, Aesthetic and Reconstructive Head and Neck Surgery, University Hospital of Wuerzburg, Josef-Schneider-Strasse 11, 97080, Würzburg, Germany.
authors.forename: Christian
authors.initials: C
authors.lastname: Ginzkey
authors.affiliation: Department of Oto-Rhino-Laryngology, Plastic, Aesthetic and Reconstructive Head and Neck Surgery, University Hospital of Wuerzburg, Josef-Schneider-Strasse 11, 97080, Würzburg, Germany.
authors.forename: Desiree
authors.initials: D
authors.lastname: Ehrmann-Müller
authors.affiliation: Department of Oto-Rhino-Laryngology, Plastic, Aesthetic and Reconstructive Head and Neck Surgery, University Hospital of Wuerzburg, Josef-Schneider-Strasse 11, 97080, Würzburg, Germany.
authors.forename: Wafaa
authors.initials: W
authors.lastname: Shehata-Dieler
authors.affiliation: Department of Oto-Rhino-Laryngology, Plastic, Aesthetic and Reconstructive Head and Neck Surgery, University Hospital of Wuerzburg, Josef-Schneider-Strasse 11, 97080, Würzburg, Germany.
authors.forename: Rudolf
authors.initials: R
authors.lastname: Hagen
mesh_terms: D000328:Adult; D000368:Aged; D065634:Cerebrospinal Fluid Leak / Q000209:etiology / Q000601:surgery*; D035301:Cranial Fossa, Middle / Q000601:surgery; D005260:Female; D006801:Humans; D008297:Male; D008866:Microsurgery / Q000009:adverse effects*; D008875:Middle Aged; D009464:Neuroma, Acoustic / Q000601:surgery*; D019635:Neurosurgical Procedures / Q000379:methods*; D011183:Postoperative Complications; D012086:Reoperation; D012189:Retrospective Studies; D012307:Risk Factors; D055815:Young Adult
keywords: Acoustic neurinoma; Csf cerebrospinal fluid leak; MCF middle cranial fossa; Management; Microsurgery; Vestibular schwannoma