Cerebrospinal Fluid Leakage During Temporal Bone Surgery: Selecting Intra-operative Dural Closure with a Dumbbell-Shaped Muscle Graft as a Surgical Approach

  • Nasrin Yazdani
  • Mohammad Taghi Khorsandi-Ashtiani
  • Hamed Tashakorinia
  • Mahtab Rabbani Anari
  • Narges Mikaniki
Original Article


Cerebrospinal fluid (CSF) leakages of the temporal bone may arise during mastoid surgery. The leakages can have multiple potential etiologies, for instance, using a cutting burr near the bony tegmen or monopolar electrocautery on the surface of the dura mater. In this paper, we introduced an effective and simple technique for the management of CSF leakages of the temporal bone. In a prospective case series, 36 patients (16 males and 20 females) who have had an experience of incidental or inevitable CSF otorrhea or otorhinorrhea during temporal bone surgery were selected. All patients were treated using a muscle graft in a dumbbell-shaped design through the dura defect at the Amir-Alam University Hospital between April 2005 and November 2008. The mean size of the defects was 5 mm (a range of 2–10 mm). A dumbbell-shaped autologous muscle graft was immediately successful in sealing the leakage in all patients. Only five patients (13.8%) had some evidence of leakage remaining on the day after the operation, which was subsequently resolved by conservative management in four of them (11.1%). Only one patient (2.7%) was subjected to a second operation for a new defect. Recurrence of CSF leakage or other related complications were not observed during about 7 years of follow up. A free autologous muscle graft, using the dumbbell technique through a small to moderate dura defect is an effective, easily performed, and safe method to seal iatrogenic leakages of the temporal bone.


Temporal bone Cerebrospinal fluid Muscle graft Leakage Ear surgery 



We are indebted to the wonderful personnel of the operating room of the Amir-Alam Hospital for their invaluable help.

Compliance with Ethical Standards

Conflict of interest

Nasrin Yazdani, Mohammad Taghi Khorsandi Ashtiani, Hamed Tashakorinia, Mahtab Rabbani Anari and Narges Mikaniki declare that they have no conflict of interest.

Ethical Standard

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. Informed consent was obtained from all individual participants included in the study.


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Copyright information

© Association of Otolaryngologists of India 2017

Authors and Affiliations

  1. 1.Otorhinolaryngology Head and Neck Surgery Department, Amir Alam University Hospital, Otorhinolaryngology Research CenterTehran University of Medical SciencesTehranIran
  2. 2.Department of Otorhinolaryngology-Head and Neck Surgery, Imam-Khomeini Hospital ComplexTehran University of Medical SciencesTehranIran

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