Prevention and Treatment of Cerebrospinal Fluid Leak After Translabyrinthine Acoustic Tumor Removal

OBJECTIVE: To determine the incidence rate of cerebrospinal fluid (CSF) leak after translabyrinthine acoustic tumor removal using titanium mesh cranioplasty and to compare with previous series and historical controls. STUDY DESIGN: Database analysis with historical controls. SETTING: Tertiary referral neurotologic private practice. PATIENTS: The series of 389 patients who underwent titanium mesh cranioplasty after translabyrinthine tumor removal between March 2003 and July 2005. The results were compared with those in a group of 1,195 translabyrinthine tumor removal patients from our previously published series and with those in a group of 324 patients from the immediately preceding two-year period. INTERVENTION: Cranioplasty using titanium mesh after acoustic tumor removal. MAIN OUTCOME MEASURES: Rates of CSF leak for this method and previous methods of closure. RESULTS: Thirteen patients (3.3%) had CSF leaks when using the new method of titanium mesh closure. This compares with rates of 10.9% and 8.7% in series in which other methods of closure were used (p < 0.001 and 0.003). The rates of CSF leak requiring reoperation were 0.5%, 2.5%, and 1.9% for the new and the two older series, respectively. CONCLUSION: In our hands, titanium mesh cranioplasty seems to reduce the rate of CSF leaks after the translabyrinthine removal of acoustic tumors.