Long-term Follow-up After Middle Cranial Fossa Spontaneous Cerebrospinal Fluid Leak Repair With Bone Cement

Introduction: Repair of spontaneous cerebrospinal fluid (sCSF) leaks of the temporal bone by the middle cranial fossa (MCF) approach with bone cement has been previously documented as effective, with significant hearing improvement. However, long-term data is lacking. This study evaluates the presence of symptoms of a recurrent leak.

Methods: In total, 54 consecutive patients underwent MCF repair of sCSF leaks with bone cement between June 2019 and August 2023. Patients were contacted and interviewed for symptoms of hearing improvement, recurrent clear otorrhea or rhinorrhea, and continuous positive airway pressure (CPAP) use. For patients reporting symptoms that could represent a recurrent leak, an in-person appointment was offered.

Results: A total of 33 patients completed the interview at a mean follow-up of 2.9 (±1.3) years. Average preoperative PTA and WRS were 37.2dB (±9.8) and 94% (±12), and 1-month postoperative PTA and WRS were 24.3dB (±9.4) and 95% (±11). Of those, 20 (61%) reported subjective hearing improvement after surgery; 100% of these patients' hearing remained improved. In patients who did not experience subjective improvement in hearing after surgery, average pure tone average (PTA) improved 15dB (±7.5). No patients developed worsened hearing after surgery or the last visit. One patient reported intermittent clear otorrhea (3%) and two (6%) reported positional rhinorrhea; it remains undetermined whether these symptoms signify a recurrent leak. None had episodes of meningitis following repair. Some 27 patients completed a polysomnogram; 25 (93%) had OSA, 15 (60%) patients diagnosed with OSA currently use CPAP, and 10 (40%) do not currently use CPAP. A sum of 14 patients completed postoperative lumbar puncture with a mean opening pressure of 22.7 (±7.9) cmH2O. A retinal exam was completed by 9 patients: 1 had grade 1 papilledema, none had CSF diversion after surgery or vision loss from papilledema.

Conclusions: This study evaluates symptoms of long-term sCSF leak recurrence following MCF repair with bone cement. We conclude MCF repair of sCSF leak with bone cement is robust, however, long-term imaging is needed.