Outcomes of the Suture "pull-Through" Technique for Repair of Lateral Skull Base CSF Fistula and Encephaloceles

Brendan P. O'Connell, Jacob B. Hunter, Alex D. Sweeney, Reid C. Thompson, Lola B. Chambless, George B. Wanna, Alejandro Rivas

Research output: Contribution to journalArticlepeer-review

9 Scopus citations


Objective: Describe the safety profile and surgical outcomes of a combined transmastoid-middle cranial fossa suture "pull-through" technique for repair of lateral skull base defects. Study Design: Retrospective. Setting: Tertiary care hospital. Patients: Patients undergoing surgery for cerebrospinal fluid (CSF) fistula and/or encephalocele. Intervention: Combined transmastoid and middle fossa approach using suture pull-through technique. Main Outcome Measures: The primary outcome measures of interest were recurrence of CSF fistula or encephalocele, and postoperative air-bone gap. Results: Twenty-six patients were included; mean age at surgery was 60 ± 14 years and 65% of patients were female. The majority of defects involved both the tegmen mastoideum and tympani (69%); multiple defects were present in 11 patients. Small craniotomy (2 × 3 cm) was performed and defects were repaired using composite grafts constructed with fascia, bone, and/or cartilage, and dural substitute affixed with suture. The suture tail was left long and passed from the middle fossa through the defect into the mastoid. At average follow-up of 8.3 months, no patients of recurrent CSF leak were noted. Significant improvements in both mean pure-tone average and air-bone gap were noted for the entire cohort (p = 0.04 and p = 0.02, respectively). Conclusion: A combined transmastoid-middle cranial fossa for the repair of lateral skull base CSF fistula and encephaloceles using the suture "pull-through" technique is efficacious and the complication profile is favorable. This method facilitates reliable placement of a composite graft in the center of lateral skull base defects through a small craniotomy that minimizes temporal lobe retraction.

Original languageEnglish (US)
Pages (from-to)416-422
Number of pages7
JournalOtology and Neurotology
Issue number3
StatePublished - Mar 1 2017


  • Encephalocele
  • Idiopathic intracranial hypertension
  • Lateral skull base defect
  • Mastoidectomy
  • Middle fossa craniotomy
  • Spinal fluid leak
  • Spontaneous cerebrospinal fluid leak
  • Suture pull through
  • Tegmen defect

ASJC Scopus subject areas

  • Otorhinolaryngology
  • Sensory Systems
  • Clinical Neurology


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