Management of Cerebrospinal Fluid Leaks During Otologic Surgery

Cerebrospinal fluid (CSF) leaks are sometimes an unavoidable complication in otology and lateral skull base surgery. Spinal fluid leaks arise from an abnormal communication between the subarachnoid space and the temporal bone. CSF leaks can arise from various etiologies including but not limited to congenital, iatrogenic, or idiopathic. While some CSF leaks can remain indolent for many years, unrecognized or undertreated CSF leaks can lead to highly morbid complications including both meningitis or brain abscesses. It is critical that otolaryngologists have an in-depth understanding of temporal bone anatomy and possess a thorough understanding of the pathophysiology and workup for CSF leaks. Surgeons must have an intricate understanding of various clinical, anatomical, and surgical factors complemented by an arsenal of techniques to best treat patients with CSF leaks.