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  • Title: Management of cerebrospinal fluid leaks involving the temporal bone: report on 92 patients.
    Author: Savva A, Taylor MJ, Beatty CW.
    Journal: Laryngoscope; 2003 Jan; 113(1):50-6. PubMed ID: 12514382.
    Abstract:
    OBJECTIVE: To investigate the success of different surgical and nonsurgical techniques in the management of cerebrospinal fluid otorrhea or otorhinorrhea. STUDY DESIGN: Retrospective case analysis. METHODS: Ninety-two patients with confirmed diagnosis of cerebrospinal fluid otorrhea or otorhinorrhea treated at our institution between 1976 and 1998 were followed up long-term by retrospective chart review and patient interviews. RESULTS: Conservative treatment was successful in most cases of cerebrospinal fluid otorrhea or otorhinorrhea resulting from head injury (26 of 29 patients). In contrast, surgical intervention was required in all but 1 of 53 patients with cerebrospinal fluid otorrhea or otorhinorrhea caused surgically. The primary operative success rate was 76.9%. When relapse occurred, the interval ranged from 0 days to 24 months (mean interval, 3.9 mo; median, 1.3 mo). All leaks requiring surgery eventually were closed successfully. Surgical results were chronologically dependent. Before 1989, 11 failures occurred in 37 primary procedures. After 1989, only 4 failures occurred in 28 primary procedures. Of seven patients undergoing primary dural closure alone, three (43%) had recurrence of the leak. Closure rates were highest among patients in whom a multilayer technique for leak closure was used: combining a primary graft or sealing material such as bone wax, free muscle, or fascia for closure of the defect with additional autologous free grafts or allogenic materials. This resulted in a 2-year closure rate of 100% compared with a 2-year rate of 75.4% for patients whose primary closure was supported by a single layer of autologous or allogenic material (P =.034). Fibrin glue with primary closure alone did not have additional benefit. Postoperative meningitis occurred in two patients and was treated without sequelae. CONCLUSIONS: Conservative treatment should be reserved for cerebrospinal fluid otorrhea or otorhinorrhea resulting from head injury. Postoperative and nontraumatic cerebrospinal fluid otorrhea or otorhinorrhea should have early operative intervention. A multilayer technique combining allogenic materials with free autologous grafts is recommended.
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