2025 Poster Presentations
P279: EFFECTIVENESS OF SURGICAL VS. CONSERVATIVE MANAGEMENT IN TEMPORAL BONE FRACTURES WITH CSF LEAKS
Caroline Bonaventure, MD; Nina Gallo, MD; Ashley Kraft, MD; Rahul Mehta, MD, FRCS; LSU Health Science Center New Orlens
Background: Cerebrospinal fluid (CSF) leaks are a significant complication of temporal bone fractures, requiring timely and effective management to prevent severe outcomes. Although temporal bone fractures resulting in persistent CSF leaks necessitating repair are rare, they can be effectively managed using a middle cranial fossa approach with multilayer closure.
Objective: This study compares the effectiveness of surgical versus conservative management in patients with temporal bone fractures complicated by CSF leaks, focusing on resolution rates and associated complications. Due to the lack of consensus on the timing and surgical approach, this study aims to provide clarity on optimal treatment strategies.
Methods: A retrospective chart review was conducted for patients diagnosed with temporal bone fractures and CSF leaks between January 2010 and December 2023. The study included patients from Our Lady of the Lake in Baton Rouge and University Medical Center in New Orleans. Management strategies, including conservative treatment and surgical intervention, and their outcomes were analyzed.
Results: Out of 440 patients, 32 (7.2%) experienced CSF leaks. Conservative treatment was utilized in 20 patients (62.5%), while lumbar drain placement was employed in six patients (18.5%). Six patients (18.5%) required surgical intervention. Despite prophylactic antibiotics, 2 patients (7.4%) developed meningitis, necessitating additional surgical and antibiotic treatment. All were found to have persistent CSF leak greater than 2 weeks from initial trauma, with varying presentations, and all were successfully repaired using middle cranial fossa approach along with a multilayer tegmen repair using bilayer AlloDerm and bone flap reconstruction. The incidence of complications was similar between the conservative and surgical groups.
Conclusion: Conservative management proves effective for most temporal bone fracture patients experiencing CSF leaks, with a high-resolution rate and a low incidence of complications. Temporal bone fractures requiring repair due to CSF leaks are rare and generally occur in more severe cases. These can be successfully managed using the middle cranial fossa approach with multilayer repair. Thus, a conservative approach should be the first line of treatment, with surgical intervention reserved for cases where conservative management is ineffective.
Keywords: Temporal bone fracture, CSF leak, conservative management, surgical intervention, meningitis, lumbar drain.