Delayed Otorrhea Following Translabyrinthine Craniotomy Approach to the Cerebellopontine Angle

Background: The translabyrinthine approach is most commonly used in the resection of internal auditory canal or cerebellopontine angle (CPA) tumors in patients with nonserviceable hearing preoperatively. Abdominal adipose tissue is typically used to obliterate the resulting dural defect. The risk of postoperative cerebrospinal fluid (CSF) leakage can be as low as 4%. Delayed leakage is rarely encountered, with the majority of CSF fistulae occurring within 5-7 days after surgery. Objective: The current paper will present patients with a history of a CPA tumor resected via a translabyrinthine approach who presented with extremely delayed (>3 years) otorrhea. Methods: Clinical charts of patients who had CPA lesions treated with a translabyrinthine approach and who presented to our clinic with delayed otorrhea from July 1988 to September 2012 were retrospectively reviewed. Results: A total of four patients were identified. Two patients developed CSF otorrhea with an encephalocele causing middle ear packing lateralization and tympanic membrane rupture. One patient developed otorrhea 26 years after surgery due to a middle ear granuloma. This resulted from a foreign body reaction to Proplast packing in the eustachian tube. Another patient developed liquified fat otorrhea 16 years after surgery due to self-induced traumatic breakdown of a previously oversewn ear canal. All patients were managed with wound revision, oversewing of the ear canal, encephalocele amputation with bipolar cautery, and repacking of the cavity with new abdominal adipose tissue. None of the patients developed additional wound complications or meningitis, and the otorrhea resolved in all cases. Conclusions: Patients who undergo the translabyrinthine approach should be counseled regarding the unusual occurrence of delayed otorrhea, and to avoid self-induced injury to the ear canal or tympanic membrane. A delay in diagnosis will occur if these patients are incorrectly treated for otitis media, otitis externa, or “swimmer’s ear.” Such a delay may lead to serious and potentially life-threatening intracranial complications.