Mastoid cavity re-aeration following the translabyrinthine approach with autologous free fat graft obliteration

To describe a rare presentation and management options of a mastoid re-aeration following a translabyrinthine approach with autologous free fat graft obliteration. We present a novel case report. A 51-year-old female underwent a TL for a 12 mm vestibular schwannoma. At 10 months post-operatively, she developed intermittent clear rhinorrhea and headaches concerning for CSF leak. CT and MRI IAC demonstrated resorption of the mastoid fat graft with partial re-aeration at the superior aspect of the mastoid cavity. Revision mastoid obliteration was considered but symptoms ultimately resolved with close observation. We report the first case of mastoid cavity re-aeration following a TL approach with autologous free fat graft obliteration. Although the causes and clinical implications of mastoid cavity re-aeration are not fully elucidated, close clinical observation and imaging is warranted given the theoretical risks of CSF leak, encephalocele formation, and meningitis in the setting of previous lateral skull base surgery.