title: Outcomes of the Suture "Pull-Through" Technique for Repair of Lateral Skull Base CSF Fistula and Encephaloceles.
abstract: Describe the safety profile and surgical outcomes of a combined transmastoid-middle cranial fossa suture "pull-through" technique for repair of lateral skull base defects.
  
  
  
  Retrospective.
  
  
  
  Tertiary care hospital.
  
  
  
  Patients undergoing surgery for cerebrospinal fluid (CSF) fistula and/or encephalocele.
  
  
  
  Combined transmastoid and middle fossa approach using suture pull-through technique.
  
  
  
  The primary outcome measures of interest were recurrence of CSF fistula or encephalocele, and postoperative air-bone gap.
  
  
  
  Twenty-six patients were included; mean age at surgery was 60 ± 14 years and 65% of patients were female. The majority of defects involved both the tegmen mastoideum and tympani (69%); multiple defects were present in 11 patients. Small craniotomy (2 × 3 cm) was performed and defects were repaired using composite grafts constructed with fascia, bone, and/or cartilage, and dural substitute affixed with suture. The suture tail was left long and passed from the middle fossa through the defect into the mastoid. At average follow-up of 8.3 months, no patients of recurrent CSF leak were noted. Significant improvements in both mean pure-tone average and air-bone gap were noted for the entire cohort (p = 0.04 and p = 0.02, respectively).
  
  
  
  A combined transmastoid-middle cranial fossa for the repair of lateral skull base CSF fistula and encephaloceles using the suture "pull-through" technique is efficacious and the complication profile is favorable. This method facilitates reliable placement of a composite graft in the center of lateral skull base defects through a small craniotomy that minimizes temporal lobe retraction.
authors.affiliation: *Department of Otolaryngology-Head and Neck Surgery, Vanderbilt University, Nashville, Tennessee †Department of Otolaryngology-Head and Neck Surgery, Baylor College of Medicine, Houston, Texas ‡Department of Neurosurgery, Vanderbilt University, Nashville, Tennessee.
authors.forename: Brendan P
authors.initials: BP
authors.lastname: O'Connell
authors.forename: Jacob B
authors.initials: JB
authors.lastname: Hunter
authors.forename: Alex D
authors.initials: AD
authors.lastname: Sweeney
authors.forename: Reid C
authors.initials: RC
authors.lastname: Thompson
authors.forename: Lola B
authors.initials: LB
authors.lastname: Chambless
authors.forename: George B
authors.initials: GB
authors.lastname: Wanna
authors.forename: Alejandro
authors.initials: A
authors.lastname: Rivas
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D065634:Cerebrospinal Fluid Leak / Q000601:surgery; D003399:Craniotomy / Q000379:methods*; D004677:Encephalocele / Q000601:surgery*; D005260:Female; D005402:Fistula / Q000601:surgery; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D019291:Skull Base / Q000601:surgery*; D013537:Sutures