Association between Lateral Skull Base Thickness and Surgical Outcomes in Spontaneous CSF Otorrhea.

Document Type

Article

Abstract

OBJECTIVES: (1) Correlate skull base thickness with perioperative outcomes for spontaneous cerebrospinal fluid (CSF) otorrhea. (2) Augment perioperative counseling of patients with abnormally thin skull bases.

STUDY DESIGN: Case series with chart review.

SETTING: Tertiary center. Patients with spontaneous CSF otorrhea have thin skull bases. This is associated with obesity and/or idiopathic intracranial hypertension. The influence of skull base thinning on perioperative outcomes is unknown.

SUBJECTS AND METHODS: A retrospective review was conducted from 2004 to 2014. Forty-eight cases of spontaneous CSF otorrhea met the inclusion criteria of primary surgery by the senior authors: preoperative dedicated temporal bone computed tomography, absence of other leak etiologies, and follow-up >6 months. Patients were stratified into thin (0.9 mm) groups based on computed tomography measures of their tegmen. Primary outcomes measures were as follows: postoperative meningitis, recurrent leak, second site leak (contralateral ear/anterior fossa), and permanent shunt placement. Hearing outcomes were not assessed in this study.

RESULTS: Thirty and 15 patients composed the thin and thick groups, respectively. Both the incidence (P < .0001) and the rate (P = .005) of adverse outcomes were significantly higher in the thin group. Only 2 patients in the thick group experienced an adverse outcome. Eleven patients underwent multiple procedures for spontaneous leaks. The recurrence rate was 14.5%. All but 1 recurrence occurred in the thin group.

CONCLUSIONS: An abnormally thin tegmen was significantly associated with adverse perioperative outcomes in cases of spontaneous CSF otorrhea. A thick skull base and the presence of an encephalocele may be protective against recurrence. The effect of untreated intracranial hypertension on the results is unknown.

Medical Subject Headings

Adult; Aged; Aged, 80 and over; Cerebrospinal Fluid Otorrhea; Female; Humans; Male; Middle Aged; Postoperative Complications; Retrospective Studies; Skull Base; Tomography, X-Ray Computed; Treatment Outcome

Publication Date

4-1-2016

Publication Title

Otolaryngology and head and neck surgery

ISSN

1097-6817

Volume

154

Issue

4

First Page

707

Last Page

714

PubMed ID

26908549

Digital Object Identifier (DOI)

10.1177/0194599816628528

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