Does packing the eustachian tube impact cerebrospinal fluid rhinorrhea rates in translabyrinthine vestibular schwannoma resections?

OBJECTIVE: To calculate cerebrospinal fluid (CSF) leak rates for translabyrinthine (TL), middle cranial fossa (MCF), and retrosigmoid/suboccipital (SO) craniotomies performed for removal of vestibular schwannoma (VS) and analyze whether packing the eustachian tube (ET) in TL VS resections impacts CSF rhinorrhea rates.

STUDY DESIGN: Retrospective.

SETTING: Tertiary care center.

METHODS: Chart review.

RESULTS: Three hundred fifty-nine VS resections were reviewed in 356 patients ranging from 10 to 86 years of age. Two hundred thirty-one TL, 70 MCF, 53 SO, and 5 combined TL/SO procedures were analyzed. Total CSF leak rates (incisional, otorrhea, and rhinorrhea) were 14.2% for TL, 11.4% for MCF, and 13.2% for SO approaches. Differences in overall CSF leak rates were not statistically significant. For those who underwent TL craniotomies, 2 groups of patients were identified based on whether their ETs were packed during surgery. In 1 group, the incus was removed, the aditus enlarged, the ET packed, and the middle ear filled with muscle. In the second group, the aditus, epitympanum and middle ear were packed without removing the incus, and the ET was not packed. Of 148 patients who had their ET packed, 12 developed CSF rhinorrhea (8.1%). The CSF rhinorrhea rate for patients who did not have ET packing was 5.9% (3 of 51 patients). This difference was not statistically significant (p = 0.80). When Proplast was used to pack the ET (121 patients), the CSF rhinorrhea rate was 5.8%. Unfortunately, this material extruded in 4 of 121 patients (3.3%) and presented clinically as delayed purulent otorrhea.

CONCLUSION: Cerebrospinal fluid leak rates were similar in patients undergoing TL, SO, and MCF approaches, and CSF rhinorrhea was not decreased by ET packing. Patients whose ETs are packed with Proplast are at risk for extrusion and otorrhea years after their initial VS resection.