Cerebrospinal fluid fistula after transtemporal skull base surgery.

OBJECTIVES: The purpose of this article is to outline our methods for the prevention and management of cerebrospinal fluid (CSF) leak after transtemporal skull base surgery. METHODS: A total of 589 patients underwent a variety of transtemporal surgical approaches for the extirpation of skull base tumors at our institution from July 1988 to October 1999. The medical records were retrospectively reviewed to identify the tumor histology, size, and location as well as the surgical approach, defect reconstruction technique, and the incidence of postoperative CSF leak. RESULTS: The risk of CSF fistulae was greatest in utilizing the restrosigmoid approach (8%) and least in those who underwent a translabyrinthine approach (4%). Tumor size had no bearing on the incidence of the CSF leak and the overall incidence of meningitis was 1.0%. CONCLUSION: The proper surgical technique will minimize the risk of CSF leak after transtemporal skull base surgery. Immediate management of CSF fistulae helped prevent meningitis in the majority of these patients.