Perez Enrique, Carlton Daniel, Alfarano Matthew, Smouha Eric
Department of Otolaryngology Head and Neck Surgery, Mount Sinai Hospital, New York, New York, United States.
Rosalind Franklin University of Medicine and Science, North Chicago, Illinois, United States.
J Neurol Surg B Skull Base. 2018 Oct;79(5):451-457. doi: 10.1055/s-0037-1617439. Epub 2018 Jan 11.
Determine the efficacy of using a purely transmastoid approach for the repair of spontaneous cerebrospinal fluid (CSF) leaks and further elucidate the relationship of elevated body mass index (BMI) and skull base thickness in our patient population. We conducted a retrospective chart review of patients treated for spontaneous temporal bone CSF leaks at our tertiary care institution from the years 2006 to 2015. Cases were categorized as primary or secondary. We analyzed success rates, length of stay, use of lumbar drains, BMIs, and rates of meningitis. Skull base thickness was compared with BMI in each case. We identified 26 primary operations for spontaneous CSF leaks and 7 secondary operations. Twenty-three of 33 repairs were performed via the transmastoid approach alone with an 87% success rate (20/23). Of the10 repairs including a middle cranial fossa (MCF) or combined MCF-transmastoid approach, 2 failed for an 80% success rate (8/10). Five transmastoid repairs underwent placement of a lumbar drain versus all 10 repairs employing an intracranial exposure. Average length of stay for those undergoing a transmastoid approach (1.7 days) was significantly shorter than for patients undergoing a MCF repair (6.3 days). Four patients presented with meningitis. Average BMI was 35.3. No correlation was established between BMI and skull base thickness ( = 0.00011). The transmastoid approach is effective in the majority of cases and prevents the need for an intracranial operation, resulting in lower morbidity and a shorter length of stay. We believe that this is the preferred primary approach in most patients with spontaneous CSF leaks.
确定单纯经乳突入路修复自发性脑脊液（CSF）漏的疗效，并进一步阐明我们患者群体中体重指数（BMI）升高与颅底厚度之间的关系。 我们对2006年至2015年在我们三级医疗机构接受治疗的自发性颞骨CSF漏患者进行了回顾性病历审查。病例分为原发性或继发性。我们分析了成功率、住院时间、腰大池引流的使用、BMI和脑膜炎发生率。对每个病例的颅底厚度与BMI进行了比较。 我们确定了26例原发性自发性CSF漏手术和7例继发性手术。33例修复手术中有23例仅通过经乳突入路进行，成功率为87%（20/23）。在包括中颅窝（MCF）或联合MCF-经乳突入路的10例修复手术中，2例失败，成功率为80%（8/10）。5例经乳突修复手术放置了腰大池引流，而所有10例采用颅内暴露的修复手术均未放置。经乳突入路患者的平均住院时间（1.7天）明显短于接受MCF修复的患者（6.3天）。4例患者发生脑膜炎。平均BMI为35.3。BMI与颅底厚度之间未建立相关性（ =0.00011）。 经乳突入路在大多数情况下是有效的，避免了开颅手术的需要，从而降低了发病率并缩短了住院时间。我们认为，这是大多数自发性CSF漏患者首选的主要入路。
