Cerebrospinal fluid fistula after transtemporal skull base surgery

OBJECTIVES: The purpose of this article is to outline our methods for the p revention and management of cerebrospinal fluid (CSF) leak after transtempo ral skull base surgery. METHODS: A fetal of 589 patients underwent a variety of transtemporal surgi cal approaches for the extirpation of skull base tumors at our institution from July 1988 to October 1999, The medical records were retrospectively re viewed to identify the tumor histology, size, and location as well as the s urgical approach, defect reconstruction technique, and the incidence of pos toperative CSF leak, RESULTS: The risk of CSF fistulae was greatest in utilizing the restrosigmo id approach (8%) and least in those who underwent a translabyrinthine appro ach (4%), Tumor size had no bearing on the incidence of the CSF leak and th e overall incidence of meningitis was 1.0%, CONCLUSION: The proper surgical technique will minimize the risk of CSF lea k after transtemporal skull base surgery, Immediate management of CSF fistu lae helped prevent meningitis in the majority of these patients.