An International Journal of Otorhinolaryngology Clinics

Register      Login

VOLUME 9 , ISSUE 3 ( September-December, 2017 ) > List of Articles

Original Article

Spontaneous Cerebrospinal Fluid Leak of Posterior Surface of Temporal Bone: Review and Case Report

Andrii G Sirko, Volodymyr V Berezniuk, Dmytro M Romanukha

Keywords : Arachnoid granulations, Posterior cranial fossa, Spontaneous cerebrospinal fluid leaks, Temporal bone

Citation Information : Sirko AG, Berezniuk VV, Romanukha DM. Spontaneous Cerebrospinal Fluid Leak of Posterior Surface of Temporal Bone: Review and Case Report. Int J Otorhinolaryngol Clin 2017; 9 (3):81-89.

DOI: 10.5005/jp-journals-10003-1272

License: CC BY-NC 4.0

Published Online: 01-03-2019

Copyright Statement:  Copyright © 2017; The Author(s).


Aim. To analyze the rarity of the clinical case report on spontaneous liquorrhea (SL) posterior cranial fossa (PCF) together with a review of the literature. To determine the features of PCF SL in contrast to anterior and middle cranial fossa (MCF) SL. To identify the optimal diagnostic and treatment tactics in patients with PCF SL. Materials and methods: We present clinical observations of a PCF SL patient and a detailed review of reports on SL with a defect on the posterior border of the petrous temporal bone (PTB). Results: Based on the literature review, 22 cases with a sufficient description were analyzed. PCF SL occurs more commonly in women than in men; middle-aged and elderly patients prevail. The average body mass index (BMI) was 33.3 ± 7, corresponding to a degree I obesity. The number of postoperative complications was quite large; each included recurrent liquorrhea. Conclusion: The data from our experience and a literature review for PCF SL patients are comparable with those of similar studies of SL in the anterior and MCF. Middle-aged and elderly women with excessive BMI are the most vulnerable. In most patients, the defect is located in the lateral regions of the posterior border of the PTB, namely anteriorly, medially from the sigmoid sinus, and below the upper petrosal sinus. A fairly high percentage of postoperative complications is due to insufficient preoperative diagnosis or intraoperative examination of the posterior PTB in patients with combined MCF and PCF defects, causing revision surgery. Clinical significance. If rhinorrhea, otorrhoea, and/or signs of intracranial space integrity loss (pneumocerephaly or latent liquorrhea with recurrent meningitis) are revealed, careful examination of bone structures of the anterior, middle, and also, be sure PCF is required, especially at the intersection with paranasal sinuses (frontal, ethmoidal, sphenoid) and mastoid air cells and PTB.

PDF Share
  1. Caltabiano GA, Viglianesi A, Bellomia D, et al. Spontaneous temporal cerebrospinal fluid leak. A case report and literature review. Neuroradiology 2010;23:420-425.
  2. Boo SH, Goh YB, Han CS. Repair of spontaneous cerebrospinal fluid otorrhea from defect of middle cranial fossa. Korean J Audiol 2013;17:148-151.
  3. Gacek RR. Arachnoid granulation cerebrospinal fluid otorrhea. Ann Otol Rhinol Laryngol 1990;99:854-862.
  4. Sanna M, Paolo F, Russo A, et al. Management of meningoencephalic herniation of the temporal bone: personal experience and literature review. Laryngoscope 2009;119:1579-1585.
  5. Rao AK, Merenda DM, Wetmore SJ. Diagnosis and management of spontaneous cerebrospinal fluid otorrhea. Otol Neurotol 2005;26:1171-1175.
  6. Kim L, Wisely CE, Dodson EE. Transmastoid approach to spontaneous temporal bone cerebrospinal fluid leaks: hearing improvement and success of repair. Otolaryngol- Head Neck Surg (United States) 2014;150:472-478.
  7. Bani A, Gilsbach JM. Incidence of cerebrospinal fluid leak after microsurgical removal of vestibular schwannomas. Acta Neurochir (Wien) 2002;144:979-982.
  8. Iannella G, Manno A, Pasqualitto E, et al. Case report massive cerebrospinal fluid leak of the temporal bone. Case Rep Otolaryngol 2016;2016:2-5.
  9. Wanna G, Young JA, Swanson E, et al. Spontaneous otogenic posterior fossa pneumocephalus. Otolaryngol–Head Neck Surg 2010;143:593-594.
  10. Mohammed ER, Profant M. Spontaneous otogenic pneumocephalus. Acta Otolaryngol 2011;131:670-674.
  11. Rabello FA, Massuda ET, de Oliveira JAA, Hyppolito MA. Otogenic Spontaneous pneumocephalus: case report. Braz J Otorhinolaryngol 2013;79:643.
  12. Rereddy SK, Mattox DE. Spontaneous defects between the mastoid and posterior cranial fossa. Acta Otolaryngol 2016;136:340-343.
  13. Pelosi S, Bederson JB, Smouha EE. Cerebrospinal fluid leaks of temporal bone origin: selection of surgical approach. Skull Base 2010;20:253-259.
  14. Pagella F, Pusateri A, Matti E, et al. Endoscopic management of spontaneous clival cerebrospinal fluid leaks: case series and literature review. World Neurosurg 2016;86:470-477.
  15. Asad S, Peters-Willke J, Brennan W, et al. Clival defect with primary csf rhinorrhea: a very rare presentation with challenging management. World Neurosurg 2017;106:1052.e1-1052.e4
  16. Alonso RC, de la Peña MJ, Caicoya AG, et al. Spontaneous skull base meningoencephaloceles and cerebrospinal fluid fistulas. Radio Graphics 2013;33:553570
  17. Grinblat G, Dandinarasaiah M, Prasad SC, et al. Temporal bone meningo-encephalic-herniation: etiological categorization and surgical strategy. Otol Neurotol 2018;39:320-322.
  18. Kutz Jr. JW, Johnson AK, Wick CC. Surgical management of spontaneous cerebrospinal fistulas and encephaloceles of the temporal bone. Laryngoscope 2018:1-8.
  19. Wick CC, Killeen DE, Clark M, et al. Posterior fossa spontaneous cerebrospinal fluid leaks. Otol Neurotol 2017;38:66-72.
  20. Nadaraja GS, Monfared A, Jackler RK. Spontaneous cerebrospinal fluid leak through the posterior aspect of the petrous bone. J Neurol Surgery, Part B Skull Base 2013;73: 71-75.
  21. Welge-Luessen A, Probst R. Spontaneous cerebrospinal fluid otorrhea in the posterior fossa as a rare cause of adult bacterial meningitis. Otolaryngol–Head Neck Surg 2004;130: 375-377.
  22. Gacek RR, Gacek MR, Tart R. Adult spontaneous cerebrospinal fluid otorrhea: diagnosis and management. Am J Otol 1999;20:770-776.
  23. Langman AW, Chu FW, Lindeman RC. Spontaneous posterior fossa cerebrospinal fluid leak. Otolaryngol Head Neck Surg 1993;108:192-195.
  24. Schuknecht HF, Zaytoun GM, Moon CN Jr. Adult-onset fluid in the tympanomastoid compartment. Diagnosis and management. Arch Otolaryngol 1982;108:759-765.
  25. Ferguson BJ, Wilkins RH, Hudson W, et al. Spontaneous CSF otorrhea from tegmen and posterior fossa defects. Laryngoscope 1986;96:635-644.
  26. Yew M, Dubbs B, Tong O, et al. Arachnoid granulations of the temporal bone: A histologic study of dural and osseous penetration. Otol Neurotol. 2011;32:602-609.
  27. Remenschneider AK, Kozin ED, Curtin H, et al. Histopathology of idiopathic lateral skull base defects. Laryngoscope. 2015;125:1798-1806.
  28. Kaufman B, Yonas H, White RJ, et al. Acquired middle cranial fossa fistulas: normal pressure and nontraumatic in origin. Neurosurgery 1979;5:466-472.
  29. Lee MH, Kim HJ, Lee IH, et al. Prevalence and appearance of the posterior wall defects of the temporal bone caused by presumed arachnoid granulations and their clinical significance: CT findings. Am J Neuroradiol 2008;29: 1704-1707.
  30. Woodworth BA, Prince A, Chiu AG, et al. Spontaneous CSF leaks: a paradigm for definitive repair and management of intracranial hypertension. Otolaryngol–Head Neck Surg 2008;138:715-720.
  31. Chaaban MR, Illing E, Riley KO, et al. Spontaneous cerebrospinal fluid leak repair: A five-year prospective evaluation. Laryngoscope 2014;124:70-75.
  32. Stone JA, Castillo M, Neelon B, et al. Evaluation of CSF leaks: high-resolution CT compared with contrast-enhanced CT and radionuclide cisternography. Am J Neuroradiol 1999;20:706-712.
  33. Eljamel M, Pidgeon C, Toland J, et al. MRI cisternography, and the localization of CSF fistula. Br J Neurosurg 1994;8:433-437.
PDF Share
PDF Share

© Jaypee Brothers Medical Publishers (P) LTD.