Surgical Outcomes Comparison of Spontaneous Middle Cranial Fossa Cerebrospinal Fluid Leaks: Systematic Review and Meta-analysis

OBJECTIVE: Spontaneous cerebrospinal fluid (sCSF) leaks of lateral skull base have little consensus on optimal management. We synthesized and evaluated current literature via systematic and meta-analysis to compare the success rates and complications of the different surgical techniques for middle cranial fossa (MCF) sCSF leak repair.

DATA SOURCES: MEDLINE, EMBASE, and Cochrane Library.

REVIEW METHODS: Studies selected concerned surgical treatment of MCF sCSF leak. Data extracted included the following: study characteristics, patient characteristics, primary outcomes, and secondary outcomes.

RESULTS: From 297 repairs with a MCF approach, the complication rate was 16.2% (95% CI: 12.3%-21.1%, I2 = 0%, P = .052), compared to transmastoid (TM) 12.2% (95% CI: 6.7%- 21.2%, I2 = 0%) in 82 repairs and for combined approaches 11.9% (95% CI: 4.2%-29.6%, I2 = 58%) in 98 repairs. The rate of recurrence with the MCF approach was 3.2% (95% CI: 1%-6.4%, I2 = 10%, P = .21) in 297 repairs, in the TM group the rate was 8.6% (95% CI: 4.7%-15%, I2 = 0%) in 125 procedures and 1.1% in the combined approaches group (0%-4.5%, I2 = 0%) in 139 procedures. Analysis of reoperation rates revealed a proportion of 0.9% (95% CI: 0%-4.4%, I2 = 51%) in 287 repairs via the MCF approach. Reoperation rate was 8.6% (95% CI: 4.7%- 15%, I2 = 0%) in 125 repairs via TM and 1.1% (95% CI: 0%-4.5%, I2 = 0%) in 139 combined approach repairs.

CONCLUSION: There is no statistically significant difference in the outcomes of repair techniques. Decision making for the preferred approach will be dependent on the location, size and number of the defects, hearing status, and in consultation with the patient.