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The Diagnosis and Treatment of Spontaneous Cerebral Spinal Fluid Otorrhea in the Adult

We describe the demographic, radiologic and surgical features in adult patients with spontaneous cerebrospinal fluid otorrhea (SCSFO). Review was made of office and hospital charts of 21 patients with SCSFO and 2 patients with spontaneous CSF rhinorrhea, which were repaired successfully from 1989 to 1998. The responsible lesions for SCSFO and rhinorrhea in the adult are arachnoid granulations (AG) or villi, which are aberrantly distributed in areas of the anterior, middle and posterior cranial fossae. The ages of the 21 patients ranged from 38 to 83 years (mean 63 years), with all but one older than 50 years. The sex ratio was 14 women to 7 men; the CSF leak was right-sided in 13 and left-sided in 8 patients. Eighteen of the spontaneous CSF leaks were located in the middle cranial fossa surface of the temporal bone (TB) while 2 were on the posterior fossa border of the TB. The middle fossa leaks were managed by craniotomy and repair with fascia, whereas the posterior fossa defects were obliterated by adipose tissue inserted through an intact canal wall mastoidectomy. The most comon radiologic finding on computerized tomography was a soft tissue mass adjacent to a tegmen bone defect. The demographic, radiologic and pathologic findings in this series of 21 TB and 2 paranasal sinus spontaneous CSF leaks support the concept that the responsible lesions are AGs that are aberrantly located adjacent to pneumatized parts of the skull.