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. 2014 Apr;75(2):117-24.
doi: 10.1055/s-0033-1359304. Epub 2013 Dec 11.

The Management of Spontaneous Otogenic CSF Leaks: A Presentation of Cases and Review of Literature

Meghan N Wilson  1 , Lawrence M Simon  1 , Moises A Arriaga  1 , Daniel W Nuss  1 , James A Lin  2
Affiliations

The Management of Spontaneous Otogenic CSF Leaks: A Presentation of Cases and Review of Literature

Meghan N Wilson et al. J Neurol Surg B Skull Base. 2014 Apr.

Abstract

Objective The types of otogenic cerebrospinal fluid (CSF) fistulae were previously classified into defects through, adjacent to, or distal to the otic capsule. This article presents cases of the three different types of spontaneous CSF fistulae and reviews pertinent literature. We examine the management of the different types of otogenic CSF leaks with modern audiovestibular testing, imaging, and surgical techniques. Design Case series and review of the literature. Setting Academic tertiary neurotologic referral practice. Participants Four patients identified through a retrospective search. Main outcome measures Resolution of CSF leak and absence of meningitis. Results Surgical intervention was performed on the four cases described in this series; none had a return of CSF otorrhea in the postoperative period or meningitis. Conclusions Otogenic CSF fistulae may lead to life-threatening infection and in congenital forms are typically not diagnosed unless meningitis has occurred. Rapid and proper recognition, work-up, and treatment of such leaks decrease the risk of permanent neurologic sequelae as well as recurrent meningitis.

Keywords: CSF fistula; CSF otorrhea; cochlear malformation.

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Figures

Fig. 1
Fig. 1
(A–D) Axial and (E, F) coronal noncontrasted computed tomography of case 1, showing an abnormal right cochlea consisting of only a basal turn (arrow).
Fig. 2
Fig. 2
(A) Axial and (B, C) coronal noncontrasted computed tomography scan of case 2, showing an poorly developed right cochlea (arrow) with only one and a half turns and opacification of the mastoid air cells on the right side.
Fig. 3
Fig. 3
(A–C) Coronal computed tomography scan showing laterally displaced facial nerve (arrows) of the patient in case 2.
Fig. 4
Fig. 4
Noncontrasted axial computed tomography scan of case 2 showing extensive pneumocephalus that developed after placement of a lumbar drain.
Fig. 5
Fig. 5
Computed tomography scan of case 3 demonstrating decrease aeration of the left mastoid and no major abnormality of the inner ear or middle ear.
Fig. 6
Fig. 6
Axial computed tomography scan at high resolution demonstrating persistent Hyrtl fissure (arrows) allowing communication between posterior fossa and middle ear space.
Fig. 7
Fig. 7
(A, B) Coronal noncontrasted computed tomography scan showing tegmen dehiscence (arrows) and underlying mastoid opacification.
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