Prevention of Cerebrospinal Fluid Leak in Translabyrinthine Surgery

Abstract

In translabyrinthine surgery leakage of cerebrospinal fluid (CSF) is a common complication which always involves a risk of postoperative meningitis. The mechanisms of leakage have been analysed in a series of 50 consecutively operated patients. The following preventive measures proved effective:

• 1. Dural closure by suturing as far as possible

• 2. Blocking the eustachian tube, the middle ear cleft, the recesses medially to the facial nerve, and the hypotympanic cell tracts with pieces of periosteum

• 3. Closure of the dural defect with a fascial graft

• 4. Filling the mastoid cavity with strips of fat

• 5. Glueing the different transplants with fibrin sealant

• 6. Firm mastoid dressing for the first 5 days

By these procedures the frequency of posterior CSF leak decreased from 36% in the first 25 patients to 8% in the next 25 patients. No liquorrhoea through the eustachian tube has occurred in the latter series, nor has any revision surgery been necessary.