Middle Fossa Craniotomy With Hydroxyapatite Cement as a Structural Repair for Noniatrogenic Cranial Cerebrospinal Fluid Leaks: A Case Series.

BACKGROUND AND

OBJECTIVES

Cranial cerebrospinal fluid (CSF) leaks due to tegmen defects can be repaired through transmastoid or transcranial surgical approaches with different repair substrates, including autologous grafts or nonimmunogenic cements. Here, we describe a case series of patients who underwent middle fossa craniotomy for repair of noniatrogenic cranial CSF leak with the use of hydroxyapatite (HA) bone cement.

METHODS

A retrospective analysis of all patients who underwent craniotomy with HA cement for repair of noniatrogenic cranial CSF leak at Henry Ford Hospital in Detroit between January 1, 2013, and September 30, 2024. Patient demographic features, presenting symptoms, location of cranial defect, comorbid conditions, and the outcomes of hospital length-of-stay and leak recurrence within 3-6 month follow-up were collected.

RESULTS

HA cement middle fossa craniotomy repair of noniatrogenic cranial CSF leak was performed in 15 patients (11 women [73%] and 4 men [27%]). The median age was 56 years (range, 29-77), and the mean body mass index was 35.7 ± 8.8 kg/m2. Most patients presented with hearing loss (n = 12; 80%) and/or encephalocele (n = 12; 80%), and more than half (n = 8; 53%) had otorrhea. There were 8 patients (53%) with obstructive sleep apnea, and only 3 (20%) had idiopathic intracerebral hypertension. Defects were located within various cranial regions, with most patients (n = 9; 60%) having a defect in the tegman tympani. The median hospital length of stay was 3 days (range, 1-28), and no patients had leak recurrence within the follow-up period.

CONCLUSION

Using HA bone cement for middle fossa craniotomy to repair cranial CSF leaks due to tegmen defects led to durable repair with no leak recurrence, suggesting that this approach may be highly effective for temporal bone repair.