Cerebrospinal Fluid Leakage During Temporal Bone Surgery: Selecting Intra-operative Dural Closure with a Dumbbell-Shaped Muscle Graft as a Surgical Approach
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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.
KeywordsTemporal 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.
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.
- 5.Marchioni D, Bonali M, Alicandri-Ciufelli M, Rubini A, Pavesi G, Presutti L (2014) Combined approach for tegmen defects repair in patients with cerebrospinal fluid otorrhea or herniations: our experience. J Neurol Surg B Skull Base 75(4):279–287. doi: 10.1055/s-0034-1371524 CrossRefPubMedPubMedCentralGoogle Scholar
- 10.Hayashi N, Mitsuya K, Gorai K, Inoue K, Ito I, Nakagawa M, Nakasu Y (2015) A novel graft material for preventing cerebrospinal fluid leakage in skull base reconstruction: technicalnote of perifascial areolar tissue. J Neurol Surg B Skull Base 76(1):7–11. doi: 10.1055/s-0034-1386655 PubMedGoogle Scholar
- 16.Freyschlag CF, Goerke SA, Obernauer J, Kerschbaumer J, Thomé C, Seiz M (2015) A sandwich technique for prevention of cerebrospinal fluid rhinorrhea and reconstruction of the sellar floor after microsurgical transsphenoidal pituitary surgery. J Neurol Surg A Cent Eur Neurosurg 77:229–232CrossRefPubMedGoogle Scholar
- 17.Cavallo LM, Solari D, Somma T, Savic D, Cappabianca P (2014) The awake endoscope-guided sealant technique with fibrin glue in the treatment of postoperative cerebrospinal fluid leak after extended transsphenoidal surgery: technical note. World Neurosurg 82(3–4):e479–e485. doi: 10.1016/j.wneu.2013.01.017 CrossRefPubMedGoogle Scholar