Outcomes Following Surgical Repair of Temporal Bone Cerebrospinal Fluid Leaks Without the Use of Lumbar Drain

Introduction: Spontaneous lateral skull base cerebrospinal fluid (CSF) leaks are a rare occurrence in the US (Kari 2011; Semaan 2011); however, rates are steadily increasing. Risk factors include obesity, obstructive sleep apnea, and idiopathic intracranial hypertension (Sanna 2009; Lobo 2017). The most common surgical repair approaches include transmastoid (TM), middle cranial fossa (MCF), and combined transmastoid-middle fossa (TM-MCF). The placement of a perioperative lumbar drain during the primary surgery is controversial with little data available on overall success and recurrence rate of CSF leaks. The objective of this study is to evaluate outcomes after surgical repair of spontaneous lateral skull base CSF leaks without the use of a lumbar drain. Methods: This study is a retrospective chart review on patients with lateral skull base spontaneous CSF leak that underwent surgical repair at a single tertiary institute from 2009 until 2024. The primary outcome was need for perioperative lumbar drain (LD). Secondary outcomes include post-operative complications, recurrence, and need for revision surgery. Statistical analysis was performed using the chi-square test. Results: In this study, a total of n = 145 patients underwent surgical repair of temporal bone spontaneous CSF leaks. 0% (0/145) of patients required perioperative LD placement, and 11.7% (17/145) of patients had recurrence of their CSF leak. There was a significant difference in recurrence rate of CSF leak based on surgical approach ( p < 0.00001). Of the patients with CSF leak recurrence, 41.2% (7/17) underwent revision surgery, and 58.8% (10/17) were managed conservatively. Conclusion: There is great success in the resolution of CSF leaks with surgical repair alone without the need for perioperative LD. The rate of CSF leak recurrence found in our study is comparable to reported averages in the literature. Thus, the use of lumbar drain is not routinely necessary in the management of spontaneous lateral skull base CSF leak repairs. Publication History Article published online: 27 February 2026 © 2026. Thieme. All rights reserved. Georg Thieme Verlag KG Oswald-Hesse-Straße 50, 70469 Stuttgart, Germany