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Management of cerebrospinal fluid otorhinorrhea complicating the retrosigmoid approach to the cerebellopontine angle.

The retrosigmoid approach is currently used in the resection of small acoustic schwannomas or the vestibular nerve in selected patients with recurrent vertigo. Cerebrospinal fluid otorhinorrhea associated with the approach is often due to a failure to completely obliterate exposed air cells of the posteromedial and posterosuperior tracts of the temporal bone. A therapeutic protocol for managing a postoperative spinal fluid leak is outlined on the basis of these anatomic features and the status of the patient's hearing. If serviceable hearing has been preserved, the operative site is explored and incompletely obliterated or exposed cells are sealed with bone wax. If a leak persists, or if hearing is lost with the initial procedure, the mastoid cavity and middle ear cleft are obliterated with abdominal fat and the eustachian tube orifice occluded with Proplast through a facial recess approach.