SUBTOTAL PETROSECTOMY IN THE TREATMENT OF CEREBROSPINAL-FLUID FISTULAS OF THE LATERAL SKULL BASE

Cerebrospinal fluid (CSF) fistulae almost invariably lead to meningiti s, even in the absence of other clinically obvious sequelae of the fis tula such as a CSF fluid leak. The only effective means of reducing th e risk of meningitis is surgical closure of the fistula. Lf surgery is to be recommended to patients with CSF fistulae even if they are curr ently asymptomatic, the morbidity of the procedure must be a principal determinant of the chosen technique. Recovery after the extracranial approach to a CSF fistula is much more rapid than after an intracrania l procedure. The extracranial route is also free of the long-term risk of epilepsy which accompanies a craniotomy. The principal disadvantag e of the lateral extracranial approach, failure of treatment, has been largely eliminated following studies into the obliteration of simple bony cavities using free adipose grafts. This paper describes our use of the extracranial approach to closure of CSF fistulae of the lateral skull base.