2025 Proffered Presentations
S048: INTRAOPERATIVE CEREBROSPINAL FLUID LEAK DURING THE MIDDLE FOSSA REPAIR OF SUPERIOR CANAL DEHISCENCE
Hong-Ho Yang, BS; Cheikh Mballo, BS; Isaac Yang, MD; Quinton Gopen, MD; David Geffen School of Medicine at UCLA
Introduction: Cerebrospinal fluid (CSF) leak is a potential complication during the middle cranial fossa (MCF) repair of superior canal dehiscence (SCD). The present investigation aims to identify preoperative predictors and clinical presentations associated with this complication.
Methods: We conducted a case-control study of consecutive MCF repairs of SCD at an institution over the past decade. Instances of intraoperative CSF leak were discovered by surgeons during repair and documented. Factors such as patient demographics, preoperative radiographic features, symptomatology, medical and surgical history factors were explored in multivariable logistic regression models as potential predictors of intraoperative CSF leak. Postoperative symptomatology was also compared between patients with and without intraoperative CSF leak.
Results: Over the study period, 426 MCF repairs of SCD were performed, and 20% of cases (n=87) were documented to have intraoperative CSF leak. Adjusting for patient sex (aOR 0.93, 95% CI 0.54-1.59), frank dehiscence (aOR 0.66, 0.29-1.49), dehiscence surface area (aOR 1.17, 0.97-1.42), tegmen angle (aOR 1.19, 0.67-2.09), and prior surgery of the affected ear (aOR 1.34, 0.73-2.49), increasing patient age (aOR 1.03, 1.01-1.06 per year, P=0.004) and surgical duration (aOR 2.47, 1.61-3.77 per hour, P<0.001) were independently associated with higher rates of intraoperative CSF leak. Every 10-year increase in age was independently associated with a 4.7% increase (95% CI 1.6%-7.9%), and every hour increase in surgical duration was independently associated with a 13.3% (95% 7.5%-19.2%) increase in the probability of intraoperative CSF leak.
Adjusting for a variety of auditory and vestibular symptoms, postoperative ear fullness was independently associated with higher rates of intraoperative CSF leak (aOR 1.75, 1.03-2.99, P=0.04). The adjusted rate of intraoperative CSF leak was 27% among those with postoperative ear fullness and 18% among those without postoperative ear fullness.
Conclusion: Older age independently predicts greater risks of intraoperative CSF leak during the MCF repair of SCD. Intraoperative CSF leak is also associated with longer operative duration and higher rates of postoperative ear fullness.