Management and Outcomes of Spontaneous Cerebrospinal Fluid Otorrhoea
Objective: A cohort of patients with spontaneous cerebrospinal fluid (sCSF) otorrhoea. To report surgical outcome and discuss a treatment protocol.Materials and Methods: Between 2012 and 2018 all patients presenting with sCSF were collected and data assessment was performed including clinical sympto...
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| Format: | Article |
| Language: | English |
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Frontiers Media S.A.
2020-04-01
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| Series: | Frontiers in Surgery |
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| Online Access: | https://www.frontiersin.org/article/10.3389/fsurg.2020.00021/full |
| _version_ | 1818957666689482752 |
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| author | Hans GXM Thomeer Hans GXM Thomeer Corine Schreurs Tristan PC van Doormaal Tristan PC van Doormaal Louise V. Straatman Louise V. Straatman |
| author_facet | Hans GXM Thomeer Hans GXM Thomeer Corine Schreurs Tristan PC van Doormaal Tristan PC van Doormaal Louise V. Straatman Louise V. Straatman |
| author_sort | Hans GXM Thomeer |
| collection | DOAJ |
| description | Objective: A cohort of patients with spontaneous cerebrospinal fluid (sCSF) otorrhoea. To report surgical outcome and discuss a treatment protocol.Materials and Methods: Between 2012 and 2018 all patients presenting with sCSF were collected and data assessment was performed including clinical symptoms (hearing loss, aural fullness, meningitis, recurrent otitis media), preoperative audiometry, CT and MRI scanning. According to the site and size of the dural defect, different surgical approaches were applied.Results: A total of 12 patients (14 operations) were included. Four of these had a history of meningitis. All beta-trace protein testings were positive. These patients were treated with different surgical approaches: middle fossa approach (MCF, seven patients), transmastoid approach (TMA) with bony obliteration of the cavity (three patients), and four patients underwent a subtotal petrosectomy (STP) procedure. Three cases underwent revision surgery (MCF or STP) due to residual disease (CFS leakage). After follow up duration of 13 months (6.5 months SD), no recurrence was observed. No severe adverse events such as cerebrovascular injury, meningitis, wound infection, or headache was observed in the postoperative course.Conclusion: Spontaneous aural cerebrospinal fluid leakage is a rare but manageable pathology with potential severe complications. Appropriate diagnosis, laboratory testing, and imaging is primordial to obtain optimal patient outcome. |
| first_indexed | 2024-12-20T11:13:29Z |
| format | Article |
| id | doaj.art-f541ef764a0f4f969cf65b525bc2b5b8 |
| institution | Directory Open Access Journal |
| issn | 2296-875X |
| language | English |
| last_indexed | 2024-12-20T11:13:29Z |
| publishDate | 2020-04-01 |
| publisher | Frontiers Media S.A. |
| record_format | Article |
| series | Frontiers in Surgery |
| spelling | doaj.art-f541ef764a0f4f969cf65b525bc2b5b82022-12-21T19:42:42ZengFrontiers Media S.A.Frontiers in Surgery2296-875X2020-04-01710.3389/fsurg.2020.00021504465Management and Outcomes of Spontaneous Cerebrospinal Fluid OtorrhoeaHans GXM Thomeer0Hans GXM Thomeer1Corine Schreurs2Tristan PC van Doormaal3Tristan PC van Doormaal4Louise V. Straatman5Louise V. Straatman6Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, NetherlandsDepartment of Otorhinolaryngology, Head and Neck Surgery, University Medical Center Utrecht, Utrecht, NetherlandsDepartment of Otorhinolaryngology, Head and Neck Surgery, University Medical Center Utrecht, Utrecht, NetherlandsBrain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, NetherlandsDepartment of Neurology and Neurosurgery, University Medical Center Utrecht, Utrecht, NetherlandsBrain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, NetherlandsDepartment of Otorhinolaryngology, Head and Neck Surgery, University Medical Center Utrecht, Utrecht, NetherlandsObjective: A cohort of patients with spontaneous cerebrospinal fluid (sCSF) otorrhoea. To report surgical outcome and discuss a treatment protocol.Materials and Methods: Between 2012 and 2018 all patients presenting with sCSF were collected and data assessment was performed including clinical symptoms (hearing loss, aural fullness, meningitis, recurrent otitis media), preoperative audiometry, CT and MRI scanning. According to the site and size of the dural defect, different surgical approaches were applied.Results: A total of 12 patients (14 operations) were included. Four of these had a history of meningitis. All beta-trace protein testings were positive. These patients were treated with different surgical approaches: middle fossa approach (MCF, seven patients), transmastoid approach (TMA) with bony obliteration of the cavity (three patients), and four patients underwent a subtotal petrosectomy (STP) procedure. Three cases underwent revision surgery (MCF or STP) due to residual disease (CFS leakage). After follow up duration of 13 months (6.5 months SD), no recurrence was observed. No severe adverse events such as cerebrovascular injury, meningitis, wound infection, or headache was observed in the postoperative course.Conclusion: Spontaneous aural cerebrospinal fluid leakage is a rare but manageable pathology with potential severe complications. Appropriate diagnosis, laboratory testing, and imaging is primordial to obtain optimal patient outcome.https://www.frontiersin.org/article/10.3389/fsurg.2020.00021/fullskull baseCSF (cerebrospinal fluid)meningitisotorrhoeahearing loss conductivesurgical reconstruction primary |
| spellingShingle | Hans GXM Thomeer Hans GXM Thomeer Corine Schreurs Tristan PC van Doormaal Tristan PC van Doormaal Louise V. Straatman Louise V. Straatman Management and Outcomes of Spontaneous Cerebrospinal Fluid Otorrhoea Frontiers in Surgery skull base CSF (cerebrospinal fluid) meningitis otorrhoea hearing loss conductive surgical reconstruction primary |
| title | Management and Outcomes of Spontaneous Cerebrospinal Fluid Otorrhoea |
| title_full | Management and Outcomes of Spontaneous Cerebrospinal Fluid Otorrhoea |
| title_fullStr | Management and Outcomes of Spontaneous Cerebrospinal Fluid Otorrhoea |
| title_full_unstemmed | Management and Outcomes of Spontaneous Cerebrospinal Fluid Otorrhoea |
| title_short | Management and Outcomes of Spontaneous Cerebrospinal Fluid Otorrhoea |
| title_sort | management and outcomes of spontaneous cerebrospinal fluid otorrhoea |
| topic | skull base CSF (cerebrospinal fluid) meningitis otorrhoea hearing loss conductive surgical reconstruction primary |
| url | https://www.frontiersin.org/article/10.3389/fsurg.2020.00021/full |
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