Tegmen tympani cerebrospinal fluid leak repair

Objective-To describe the transmastoid approach for closing cerebrospinal fluid leaks in the tegmen tympani using autologous materials (temporal muscle fascia and abdominal fat) and heterologous materials (bovine collagen), together with its advantages and disadvantages. Material and Methods-We present the cases of three patients who underwent closure of spontaneous cerebrospinal fluid leaks in the tegmen tympani in which we used the transmastoid approach and autologous and heterologous materials. The three patients underwent canal wall-up mastoidectomy, posterior tympanotomy, removal of the malleus head and incus and, consequently, exposure of the tegmen tympani and the cerebrospinal fluid leak. Closure was performed using temporal muscle fascia, abdominal fat and bovine collagen, fixed in place with fibrin glue. A lumbar shunt was established, as is routine. Results-The cerebrospinal fluid leak was closed in all patients using the technique described, with a minimum follow-up of 14 months. Conclusion-The technique presented herein is an excellent option in cases of cerebrospinal fluid leakage in the tegmen tympani; it is easy to perform and results in minimal risk to patients.