Prevention and treatment of cerebrospinal fluid leak after translabyrinthine acoustic tumor removal.

OBJECTIVE

To determine the incidence rate of cerebrospinal fluid (CSF) leak after translabyrinthine acoustic tumor removal using titanium mesh cranioplasty and to compare with previous series and historical controls.

STUDY

DESIGN

Database analysis with historical controls.

SETTING

Tertiary referral neurotologic private practice.

PATIENTS: The series of 389 patients who underwent titanium mesh cranioplasty after translabyrinthine tumor removal between March 2003 and July 2005. The results were compared with those in a group of 1,195 translabyrinthine tumor removal patients from our previously published series and with those in a group of 324 patients from the immediately preceding two-year period.

INTERVENTION: Cranioplasty using titanium mesh after acoustic tumor removal.

MAIN OUTCOME MEASURES: Rates of CSF leak for this method and previous methods of closure.

RESULTS

Thirteen patients (3.3%) had CSF leaks when using the new method of titanium mesh closure. This compares with rates of 10.9% and 8.7% in series in which other methods of closure were used (p < 0.001 and 0.003). The rates of CSF leak requiring reoperation were 0.5%, 2.5%, and 1.9% for the new and the two older series, respectively.

CONCLUSION

In our hands, titanium mesh cranioplasty seems to reduce the rate of CSF leaks after the translabyrinthine removal of acoustic tumors.