[Personalized surgical management of otogenic cerebrospinal fluid leak].

INTRODUCTION

Otogenic cerebrospinal fluid leak is a condition that requires surgery due to the risk of developing potentially life-threatening meningitis. The surgical approach should consider the location of the defect, the status of the middle ear cavity, the hearing threshold, and the etiology.

OBJECTIVE

To summarize our experience with personalized closure techniques for leak.

METHOD: Retrospective analysis of data from patients who underwent closure in our department between April 2022 and June 2024, regarding surgical success and hearing outcomes.

RESULTS

During the aforementioned period, 8 patients underwent closure of the fistula as the exclusive goal of the surgery. Idiopathic cerebrospinal fluid leakage was the most common cause (four cases), while iatrogenic origin due to a previous operation in 2 patients, and destructive cholesteatoma and necrotizing external otitis in the other 2 patients. Besides the typical clinical features, the diagnosis was based on CT scans, a positive beta-trace protein test and/or cerebrospinal fluid scintigraphy. The fistula was closed by the transmastoid approach in 2 patients, via middle fossa approach in 3 cases, and with subtotal petrosectomy in 3 patients. All surgeries were successful regarding the closure of the cerebrospinal fluid leak, however, the patient with the extensive necrotizing external otitis died two weeks after the operation. 4 patients were preoperatively deaf, and average air-conduction thresholds of 26 dB and air-bone gap of 12 dB were measured in the other 6 patients postoperatively.

CONCLUSION

Personalized surgical management considering the location of the lesion, the otological status, and the preoperative hearing threshold is an effective intervention for the targeted treatment of otogenic cerebrospinal fluid leak. Orv Hetil. 2026; 167(9): 331-336.