Twenty Years of Success with an Otomimix Technique for Repairing CSF Leak after Middle Cranial Fossa Craniotomy
Recommended Citation
Shaftel K, Hamilton T, Brainard L, Angster K, Rock J. Twenty Years of Success with an Otomimix Technique for Repairing CSF Leak after Middle Cranial Fossa Craniotomy. J Neurol Surg B Skull Base 2024; 85(S1).
Document Type
Conference Proceeding
Publication Date
2-5-2024
Publication Title
J Neurol Surg B Skull Base
Abstract
Introduction: Spontaneous CSF leaks from the floor of the middle cranial fossa and not uncommon and are associated with a complaint of ear fullness and hearing loss which is generally conductive. We have successfully surgically managed over 30 patients over the last 20 years by middle fossa craniotomy and CSF leak repair. Methods: A middle fossa craniotomy followed with extradural exposure of the leak site and associated encephalocoele. After removal of the encephalocoele, placement of Gelfoam in the defect followed by placement of Otomimix closes the leak primarily. Then Duragen is placed over the dural defect and tenting sutures are placed in the dura and the craniotomy closed. Results: All patients had preoperative high resolution temporal bone CT for identification of leak location. Eighteen patients with follow-up data have had identical surgical technique for leak closure and all leaks were successfully closed with no recurrence of the leak on 3- to 6-month follow-up. Discussion: Various surgical techniques have been used for management of postoperative middle cranial fossa CSF leaks due to tegmen defects. It is not uncommon for the mastoidectomy cavity to be filled with an abdominal fat graft followed by glue. More complex options include autologous temporalis fascia, split calvarial bone grafts, cellulose grafts, or auricular cartilage are also often used. There is a paucity in the literature comparing the statistical outcomes of these various techniques. Our technique using Otomimix, however, has 100% efficacy in treating CSF leaks. Otomimix is a hydroxyapatite bone cement initially designed for repair of the ossicles within the middle ear. It has the benefits of easy preparation, rapidly hardening in a wet environment, as well as osseointegration into bone for a permanent effect, making it ideal for the application of tegmen defects. While it has been documented to have roughly 5% risk of infection, none of our patients experienced an infection after the use of Otomimix. Our technique using Otomimix is to first place a Gelfoam plug into the middle fossa defect to prevent extrusion of the Otomimix onto the ossicular heads, which would lead to a conductive hearing loss. We then apply the Otomimix over the entire exposed surface of the middle fossa to prevent persistent microdefects from leaking postoperatively. Duragen is then applied over the dural defect as well as tenting sutures in the dura prior to closure of the craniotomy with a plating system. Conclusions: The described surgical technique for CSF leak closure is simple and effective.
Volume
85
Issue
S1
