Comparing Outcomes and Billing Costs of Middle Cranial Fossa and Transmastoid Approaches for Otogenic Encephalocele and Cerebrospinal Fluid Leak Repair

Objective Comparison of outcomes and billing costs of patients treated at our institution using transmastoid (TM), middle cranial fossa (MCF), and combined approaches for repair of otogenic cerebrospinal fluid (CSF) leaks and encephaloceles. Study Design Retrospective cohort review. Setting Tertiary-care hospital. Patients Seventy-seven cases of otogenic CSF leaks or encephaloceles. Interventions Surgical repair of an otogenic encephalocele or CSF leak using either a TM, MCF, or combined approach. Main Outcome Measures Success of repair, length of operation, cost of operating room materials, postoperative need for intensive care, and postoperative length of stay. Results Forty cases (52%) were performed by the TM approach, 27 (35%) by MCF, and 10 (13%) by combined TM/MCF. Mean length of stay was not statistically different amongst TM patients (2.1 d), MCF patients (3.3 d), and combined TM/MCF patients (3.70; p = 0.112). Only 3/40 TM cases required intensive care during their admission while all MCF and combined TM/MCF approach cases were admitted to the intensive care unit for at least one night (p < 0.001). On follow-up, CSF leak recurred in 3/77 (4%) cases: 3/27 (11%) MCF, 0/40 TM, and 0/10 combined TM/MCF patients (p = 0.056). The mean cost of operating room materials charged to the patient was significantly greater in the MCF group ($9,883) than the TM group ($3,748; p = 0.001). Conclusions In carefully selected patients, the TM approach is an effective and less costly alternative to MCF approaches for repair of otogenic CSF leaks and encephaloceles.