Sn. Dutt et al., Middle cranial fossa approach for the repair of spontaneous cerebrospinal fluid otorrhoea using autologous bone pate, CLIN OTOLAR, 26(2), 2001, pp. 117-123
Tegmen plate defects causing cerebrospinal fluid (CSF) leaks and brain hern
ias have conventionally been repaired using soft tissue grafts by a transma
stoid approach. A review of the literature reveals that the results of tran
smastoid repairs have been less than satisfactory. We present here four pat
ients with spontaneous CSF otorrhoea who had tegmen defects repaired using
the middle cranial fossa approach. An autologous bone pare slab mixed with
fibrin glue with additional temporalis fascia reinforcement was used for th
e repairs. All four patients had uneventful postoperative periods and have
had no subsequent CSF leak (follow-up range: 1-3 years). We believe that th
e middle cranial fossa approach is more effective than the transmastoid app
roach for the repair of CSF leaks and brain hernias through tegmen plate de
fects. An important additional benefit is hearing preservation. We also rec
ommend the use of bone pate along with soft tissue for the repair in order
to achieve a secure seal. Bone pate can effectively seal multiple defects i
n the tegmen plate without any risk of migration.