, longue de deux jours en moyenne pour les patients présentant une fuite de LCS par rapport à ceux ne présentant pas de fuite

, Jacob et al. (45), chez 231 patients opérés par voie TL, ne retrouvent pas de différence statistiquement significative (p=0,80) entre le groupe avec obturation (8,1% de RCS)

. La-méta-analyse-de-selesnick, regroupant 17 études avec un total de 3118 patients opérés par voie TL, retrouve que le fait d'obturer la TE par du fascia lata, du fascia temporalis ou du muscle temporal, est une technique couramment utilisée mais n'est pas correlée à un taux de fuite inférieur à la moyenne globale de 9,5%. A l'inverse, Ekvall et Bynke (64), chez 115 patients opérés par voie TL, concluent à l'importance de l'obturation de la TE pour prévenir la RCS. Bryce et al. (27) expliquent que l'oblitération de la TE est transitoire et a pour objectif de diminuer le flux de LCS afin de laisser le temps aux autres routes potentielles de s'étanchéifier ; ainsi, à 6 mois post-opératoire, la caisse du tympan était normalement aérée. Un des possibles effets secondaires de cette technique, 2004.

, Parmi les patients opérés par voie RS, le colmatage des cellules exposées du mur postérieur du MAI est statistiquement associé à la survenue de RCS (p=0,024)

. L'importance-de-la-pneumatisation-péri-sigmoïdienne and . Post, opératoire ne semblent pas liés. L'importance de la pneumatisation de l'apex pétreux et le risque de RCS ne semblent pas liés. Cependant, la pneumatisation du mur postérieur du MAI augmente le risque de RCS, en particulier dans les voies RS. La voie d'abord, le sexe, l'âge, l'IMC et le stade tumoral ne sont pas statistiquement liés à la survenue de RCS. L'obturation de la TE dans les voies TL ne

R. Bibliographiques,

V. Darrouzet, V. Franco-vidal, and D. Liguoro, Neurinome de l'acoustique. EMC -Oto-Rhino-Laryngol, janv, vol.1, issue.3, pp.1-25, 2006.

H. Cushing, Tumors of the Nervus Acusticus and the Syndrome of the Cerebellopontile Angle, WB Saunders, 1917.

W. E. Dandy, RESULTS OF REMOVAL OF ACOUSTIC TUMORS BY THE UNILATERAL APPROACH. Arch Surg. 1 juin, vol.42, issue.6, p.1026, 1941.

W. F. House, Report of cases. Monograph: transtemporal bone microsurgical removal of acoustic neuromas, Arch Otolaryngol, vol.80, pp.617-667, 1964.

H. Marx, Zur chirurgie der kleinhirnbruckenwinkeltumoren. Mitt Grenzgeb Med Chir, vol.26, pp.117-151, 1913.

M. Samii and C. Matthies, Management of 1000 vestibular schwannomas (acoustic neuromas): hearing function in 1000 tumor resections, Neurosurgery. févr, vol.40, issue.2, pp.248-60, 1997.

M. Samii, V. Gerganov, and A. Samii, Improved preservation of hearing and facial nerve function in vestibular schwannoma surgery via the retrosigmoid approach in a series of 200 patients, J Neurosurg, vol.105, issue.4, pp.527-562, 2006.

L. Gilain, D. Bouccara, I. Jacquier, J. Achouche, J. M. Casteran et al., Diagnostic strategy of acoustic neuroma. Evaluation of efficacy of auditory evoked potentials. Apropos of a series of 50 neuroma cases

A. Chir, Cervico Faciale Bull Soc Oto-Laryngol Hopitaux Paris, vol.108, issue.5, pp.257-60, 1991.

R. A. Cueva, Auditory brainstem response versus magnetic resonance imaging for the evaluation of asymmetric sensorineural hearing loss. The Laryngoscope, vol.114, pp.1686-92, 2004.

L. H. Stieglitz, K. H. Wrede, A. Gharabaghi, V. M. Gerganov, A. Samii et al., Factors affecting postoperative cerebrospinal fluid leaks after retrosigmoidal craniotomy for vestibular schwannomas, J Neurosurg, vol.111, issue.4, pp.874-83, 2009.

W. B. Gormley, L. N. Sekhar, D. C. Wright, D. Kamerer, and D. Schessel, Acoustic neuromas: results of current surgical management, Neurosurgery. juill, vol.41, issue.1, pp.50-58, 1997.

R. M. Irving, R. K. Jackler, and L. H. Pitts, Hearing preservation in patients undergoing vestibular schwannoma surgery: comparison of middle fossa and retrosigmoid approaches, J Neurosurg. mai, vol.88, issue.5, pp.840-845, 1998.

T. H. Lanman, D. E. Brackmann, W. E. Hitselberger, and B. Subin, Report of 190 consecutive cases of large acoustic tumors (vestibular schwannoma) removed via the translabyrinthine approach, J Neurosurg. avr, vol.90, issue.4, pp.617-640, 1999.

P. Sampath, D. Rini, and D. M. Long, Microanatomical variations in the cerebellopontine angle associated with vestibular schwannomas (acoustic neuromas): a retrospective study of 1006 consecutive cases, J Neurosurg. janv, vol.92, issue.1, pp.70-78, 2000.

T. Mom, A. Montalban, T. Khalil, J. Gabrillargues, J. Chazal et al., Vasospasm of labyrinthine artery in cerebellopontine angle surgery: evidence brought by distortionproduct otoacoustic emissions, Eur Arch Oto-Rhino-Laryngol Off J Eur Fed Oto-Rhino-Laryngol Soc EUFOS Affil Ger Soc Oto-Rhino-Laryngol -Head Neck Surg, vol.271, issue.10, pp.2627-2662, 2014.

B. Lourenço, B. Madero, S. Tringali, X. Dubernard, T. Khalil et al., Non-invasive intraoperative monitoring of cochlear function by cochlear microphonics during cerebellopontine-angle surgery, Eur Arch Oto-Rhino-Laryngol Off J Eur Fed Oto-Rhino-Laryngol Soc EUFOS Affil Ger Soc Oto-Rhino-Laryngol -Head Neck Surg. janv, vol.275, issue.1, pp.59-69, 2018.

S. L. Nutik and H. W. Korol, Cerebrospinal fluid leak after acoustic neuroma surgery, Surg Neurol. juin, vol.43, issue.6, pp.556-557, 1995.

M. J. Ebersold, S. G. Harner, C. W. Beatty, C. M. Harper, and L. M. Quast, Current results of the retrosigmoid approach to acoustic neurinoma, J Neurosurg. juin, vol.76, issue.6, pp.901-910, 1992.

M. E. Glasscock, J. F. Kveton, C. G. Jackson, S. C. Levine, and K. X. Mckennan, A systematic approach to the surgical management of acoustic neuroma. The Laryngoscope, vol.96, pp.1088-94, 1986.

L. Symon, L. T. Bordi, J. S. Compton, I. H. Sabin, and E. Sayin, Acoustic neuroma: a review of 392 cases, Br J Neurosurg, vol.3, issue.3, pp.343-350, 1989.

M. Bernal-sprekelsen, I. Alobid, J. Mullol, F. Trobat, and M. Tomás-barberán, Closure of cerebrospinal fluid leaks prevents ascending bacterial meningitis, Rhinology. déc, vol.43, issue.4, pp.277-81, 2005.

D. Santamarta, J. A. Blázquez, A. Maillo, A. Muñoz, M. Caballero et al., Analysis of cerebrospinal fluid related complications (hydrocephalus, fistula, pseudomeningocele and infection) following surgery for posterior fossa tumors

, Neurocir Astur Spain. avr, vol.14, issue.2, pp.117-143, 2003.

J. Leonetti, D. Anderson, S. Marzo, and G. Moynihan, Cerebrospinal fluid fistula after transtemporal skull base surgery. Otolaryngol--Head Neck Surg Off J Am Acad Otolaryngol-Head Neck Surg, vol.124, pp.511-515, 2001.

S. G. Harner, C. W. Beatty, and M. J. Ebersold, Retrosigmoid removal of acoustic neuroma: experience 1978-1988. Otolaryngol--Head Neck Surg Off J Am Acad Otolaryngol-Head Neck Surg, juill, vol.103, issue.1, pp.40-45, 1990.

G. S. Gillman and L. S. Parnes, Acoustic neuroma management: a six-year review, J Otolaryngol. juin, vol.24, issue.3, pp.191-198, 1995.

R. A. Hoffman, Cerebrospinal fluid leak following acoustic neuroma removal. The Laryngoscope, janv, vol.104, issue.1, pp.40-58, 1994.

G. E. Bryce, J. M. Nedzelski, D. W. Rowed, and J. M. Rappaport, Cerebrospinal fluid leaks and meningitis in acoustic neuroma surgery. Otolaryngol--Head Neck Surg Off J Am Acad Otolaryngol-Head Neck Surg, janv, vol.104, issue.1, pp.81-88, 1991.

G. Magliulo, C. Sepe, S. Varacalli, and M. Fusconi, Cerebrospinal fluid leak management following cerebellopontine angle surgery, J Otolaryngol. oct, vol.27, issue.5, pp.258-62, 1998.

G. K. Rodgers and W. M. Luxford, Factors affecting the development of cerebrospinal fluid leak and meningitis after translabyrinthine acoustic tumor surgery. The Laryngoscope. sept, vol.103, pp.959-62, 1993.

I. Yamakami, T. Serizawa, A. Yamaura, and T. Nakamura, No Shinkei Geka. janv, vol.24, issue.1, pp.29-33, 1996.

S. H. Selesnick, J. C. Liu, J. A. Newman, and J. , The incidence of cerebrospinal fluid leak after vestibular schwannoma surgery, Otol Neurotol Off Publ Am Otol Soc Am Neurotol Soc Eur Acad Otol Neurotol. mai, vol.25, issue.3, pp.387-93, 2004.

R. A. Lebowitz, R. A. Hoffman, J. T. Roland, and N. L. Cohen, Autologous fibrin glue in the prevention of cerebrospinal fluid leak following acoustic neuroma surgery, Am J Otol. mars, vol.16, issue.2, pp.172-176, 1995.

W. W. Montgomery, Translabyrinthine resection of the small acoustic neuroma, Arch Otolaryngol Chic Ill, vol.89, issue.2, pp.319-344, 1960.

P. J. Catalano, K. Post, C. Sen, P. Costantino, and C. Friedman, Prevention of cerebrospinal fluid rhinorrhea in neurotologic surgery, Am J Otol. mars, vol.21, issue.2, pp.265-274, 2000.

H. J. Valtonen, D. S. Poe, C. B. Heilman, and E. C. Tarlov, Endoscopically assisted prevention of cerebrospinal fluid leak in suboccipital acoustic neuroma surgery, Am J Otol. mai, vol.18, issue.3, pp.381-386, 1997.

S. M. Celikkanat, E. Saleh, A. Khashaba, A. Taibah, A. Russo et al., Cerebrospinal fluid leak after translabyrinthine acoustic neuroma surgery. Otolaryngol--Head Neck Surg Off J Am Acad Otolaryngol-Head Neck Surg, juin, vol.112, issue.6, pp.654-662, 1995.

F. Domengie, J. P. Cottier, E. Lescanne, B. Aesch, C. Vinikoff-sonier et al.,

, J Neuroradiol J Neuroradiol. janv, vol.31, issue.1, pp.47-59, 2004.

S. Han, M. H. Song, J. Kim, W. Lee, and H. Lee, Classification of temporal bone pneumatization based on sigmoid sinus using computed tomography, Clin Radiol, vol.62, issue.11, pp.1110-1118, 2007.

C. Virapongse, M. Sarwar, S. Bhimani, C. Sasaki, and R. Shapiro, Computed tomography of temporal bone pneumatization: 1. Normal pattern and morphology, AJR Am J Roentgenol. sept, vol.145, issue.3, pp.473-81, 1985.

M. Falcioni, J. J. Mulder, A. Taibah, D. Donato, G. Sanna et al., No cerebrospinal fluid leaks in translabyrinthine vestibular schwannoma removal: reappraisal of 200 consecutive patients

, Am J Otol. sept, vol.20, issue.5, pp.660-666, 1999.

J. W. Brennan, D. W. Rowed, J. M. Nedzelski, and J. M. Chen, Cerebrospinal fluid leak after acoustic neuroma surgery: influence of tumor size and surgical approach on incidence and response to treatment, J Neurosurg. févr, vol.94, issue.2, pp.217-240, 2001.

A. Bani and J. M. Gilsbach, Incidence of cerebrospinal fluid leak after microsurgical removal of vestibular schwannomas, Acta Neurochir, vol.144, issue.10, pp.979-982, 2002.

S. S. Becker, R. K. Jackler, and L. H. Pitts, Cerebrospinal fluid leak after acoustic neuroma surgery: a comparison of the translabyrinthine, middle fossa, and retrosigmoid approaches, Otol Neurotol Off Publ Am Otol Soc Am Neurotol Soc Eur Acad Otol Neurotol. janv, vol.24, issue.1, pp.107-119, 2003.

A. J. Fishman, M. S. Marrinan, J. G. Golfinos, N. L. Cohen, and J. T. Roland, Prevention and management of cerebrospinal fluid leak following vestibular schwannoma surgery, The Laryngoscope. mars, vol.114, issue.3, pp.501-506, 2004.

A. Jacob, J. S. Bortman, L. L. Robinson, L. Yu, E. E. Dodson et al., Does packing the eustachian tube impact cerebrospinal fluid rhinorrhea rates in translabyrinthine vestibular schwannoma resections?, Otol Neurotol Off Publ Am Otol Soc Am Neurotol Soc Eur Acad Otol Neurotol, vol.28, issue.7, pp.934-942, 2007.

L. H. Stieglitz, M. Giordano, V. Gerganov, A. Raabe, A. Samii et al., Petrous bone pneumatization is a risk factor for cerebrospinal fluid fistula following vestibular schwannoma surgery, Neurosurgery. déc, vol.67, issue.2, pp.509-524, 2010.

J. C. Goddard, E. R. Oliver, and P. R. Lambert, Prevention of cerebrospinal fluid leak after translabyrinthine resection of vestibular schwannoma, Otol Neurotol Off Publ Am Otol Soc Am Neurotol Soc Eur Acad Otol Neurotol. avr, vol.31, issue.3, pp.473-480, 2010.

L. H. Stieglitz, M. Giordano, V. M. Gerganov, A. Samii, M. Samii et al., How obliteration of petrosal air cells by vestibular schwannoma influences the risk of postoperative CSF fistula, Clin Neurol Neurosurg, vol.113, issue.9, pp.746-51, 2011.

W. R. Copeland, G. W. Mallory, B. A. Neff, C. Driscoll, and M. J. Link, Are there modifiable risk factors to prevent a cerebrospinal fluid leak following vestibular schwannoma surgery?, J Neurosurg. févr, vol.122, issue.2, pp.312-318, 2015.

A. Russel, C. P. Hoffmann, D. T. Nguyen, R. Beurton, and C. Parietti-winkler, Can the Risks of Cerebrospinal Fluid Leak After Vestibular Schwannoma Surgery Be Predicted?, Otol Neurotol Off Publ Am Otol Soc Am Neurotol Soc Eur Acad Otol Neurotol, vol.38, issue.2, pp.248-52, 2017.

M. Tos, J. Thomsen, and A. Harmsen, Results of translabyrinthine removal of 300 acoustic neuromas related to tumour size, Acta Oto-Laryngol Suppl, vol.452, pp.38-51, 1988.

A. F. Allam, Pneumatization of the temporal bone, Ann Otol Rhinol Laryngol. févr, vol.78, issue.1, pp.49-64, 1969.

A. Jen, P. C. Sanelli, V. Banthia, J. D. Victor, and S. H. Selesnick, Relationship of petrous temporal bone pneumatization to the eustachian tube lumen, The Laryngoscope. avr, vol.114, issue.4, pp.656-60, 2004.

I. Yamakami, Y. Uchino, E. Kobayashi, and A. Yamaura, Computed tomography evaluation of air cells in the petrous bone--relationship with postoperative cerebrospinal fluid rhinorrhea, Neurol Med Chir (Tokyo). juill, vol.43, issue.7, pp.334-342, 2003.

A. R. Maw, W. Otoneurosurgery-pellet, M. Cannoni, A. Pech, and . Springer-verlag, ISBN 3-540-50979-8. Price DM298. Pp 220. Figs 139, J Laryngol Otol. avr, vol.105, issue.4, pp.325-325, 1990.

J. Lang and A. G. Kerr, Pneumatization of the posteromedial air-cell tract, Clin Otolaryngol Allied Sci, vol.14, issue.5, pp.425-432, 1989.

A. Diaz-anadon, L. Lassaletta, J. M. Roda, G. Bouzas, and J. , CSF fistulae following surgery for cerebellopontine angle tumours and their relationship with the body mass index

, Acta Otorrinolaringol Esp, vol.60, issue.5, pp.318-342, 2009.

A. V. Mantravadi, J. P. Leonetti, R. Burgette, G. Pontikis, S. J. Marzo et al., Body mass index predicts risk for complications from transtemporal cerebellopontine angle surgery. Otolaryngol--Head Neck Surg Off J Am Acad Otolaryngol-Head Neck Surg, mars, vol.148, issue.3, pp.460-465, 2013.

J. C. Goddard, T. Meyer, S. Nguyen, and P. R. Lambert, New considerations in the cause of spontaneous cerebrospinal fluid otorrhea, Otol Neurotol Off Publ Am Otol Soc Am Neurotol Soc Eur Acad Otol Neurotol. août, vol.31, issue.6, pp.940-945, 2010.

W. C. Scurry, S. A. Ort, W. M. Peterson, J. M. Sheehan, and J. E. Isaacson, Idiopathic temporal bone encephaloceles in the obese patient. Otolaryngol--Head Neck Surg Off J Am Acad Otolaryngol-Head Neck Surg, juin, vol.136, issue.6, pp.961-966, 2007.

W. O. Lüdemann, L. H. Stieglitz, V. Gerganov, A. Samii, and M. Samii, Fat implant is superior to muscle implant in vestibular schwannoma surgery for the prevention of cerebrospinal fluid fistulae, Neurosurgery. juill, vol.63, issue.1, pp.42-43, 2008.

M. E. Glasscock, J. W. Hays, C. G. Jackson, and R. L. Steenerson, A one-stage combined approach for the management of large cerebellopontine angle tumors. The Laryngoscope, vol.88, pp.1563-76, 1978.

G. B. Hughes, M. E. Glasscock, J. W. Hays, C. G. Jackson, and A. Sismanis, Cerebrospinal fluid « leaks » and meningitis following acoustic tumor surgery. Otolaryngol--Head Neck Surg Off J Am Acad Otolaryngol-Head Neck Surg, févr, vol.90, issue.1, pp.117-142, 1982.

L. Ekvall and O. Bynke, Prevention of cerebrospinal fluid rhinorrhea in translabyrinthine surgery, Acta Oto-Laryngol Suppl, vol.449, pp.15-21, 1988.

, Reçu(e) à l'intérieur des maisons, je respecterai les secrets des foyers et ma conduite ne servira pas à corrompre les moeurs. Je ferai tout pour soulager les souffrances. Je ne prolongerai pas abusivement les agonies

, Je n'entreprendrai rien qui dépasse mes compétences. Je les entretiendrai et les perfectionnerai pour assurer au mieux les services qui me seront demandés

, J'apporterai mon aide à mes confrères ainsi qu'à leurs familles dans l'adversité

, Que les hommes et mes confrères m'accordent leur estime si je suis fidèle à mes promesses ; que je sois déshonoré(e) et méprisé(e) si j'y manque