Surgical management of CSF otorhinorrhea following retrosigmoid removal of cerebellopontine angle tumors.

Cerebrospinal fluid (CSF) otorhinorrhea continues to be one of the most common complications following surgery for cerebellopontine angle (CPA) tumors. For retrosigmoid approaches, this complication has been reported to occur in 12-19 percent of patients. Nearly all prior surgical attempts at control have included middle ear and eustachian tube obliteration along with packing of the mastoid. This article reviews 165 retrosigmoid procedures (January 1982-December 1990) for removal of CPA tumors, with a leak rate of 9.8 percent (16 cases), 7.2 percent (12 cases) requiring surgical control. An operative technique involving only mastoid obliteration is presented. This approach is less invasive as it limits the scope of the surgical field and also maintains the integrity of the middle ear for potential preservation of hearing. This approach has resulted in control in 100 percent of the patients, without reoperation. The routes of the CSF leak, the technique, and the rationale for its use are presented.