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In addition, other pre- and postoperative risk factors for CSF leakage after ATPA are discussed.<\/jats:p><\/jats:sec><jats:sec><jats:title>METHODS<\/jats:title><jats:p>Preoperative and postoperative target imaging of the temporal bone was performed in a total of 117 patients who underwent ATPA, and various surgery-related parameters were analyzed.<\/jats:p><\/jats:sec><jats:sec><jats:title>RESULTS<\/jats:title><jats:p>The existence of air cells at the petrous apex, as well as fluid collection in the mastoid antrum detected by a postoperative CT scan, were possible risk factors for CSF leakage. Tracts that directly connected to the antrum from the squamous part of the temporal bone and petrous apex, rather than through numerous air cells, were significantly related to CSF leak and were defined as \u201cdirect tract.\u201d All patients with a refractory CSF leak possessed \u201cunusual tracts\u201d that connected to the attic, tympanic cavity, or eustachian tube, rather than through the mastoid antrum.<\/jats:p><\/jats:sec><jats:sec><jats:title>CONCLUSIONS<\/jats:title><jats:p>Preoperative assessment of petrous pneumatization types is necessary to prevent CSF leaks. Direct and unusual tracts are particularly strong risk factors for CSF leaks.<\/jats:p><\/jats:sec>","DOI":"10.3171\/2017.9.jns171622","type":"journal-article","created":{"date-parts":[[2018,3,16]],"date-time":"2018-03-16T13:59:39Z","timestamp":1521208779000},"page":"360-367","source":"Crossref","is-referenced-by-count":25,"title":["Analysis of various tracts of mastoid air cells related to CSF leak after the anterior transpetrosal approach"],"prefix":"10.3171","volume":"130","author":[{"given":"Ryota","family":"Tamura","sequence":"first","affiliation":[{"name":"Department of Neurosurgery, Keio University School of Medicine, Tokyo;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ryosuke","family":"Tomio","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Mihara Memorial Hospital, Gunma, Japan; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Farrag","family":"Mohammad","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Keio University School of Medicine, Tokyo;"},{"name":"Department of Neurosurgery, Assiut University, Assiut, Egypt"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Masahiro","family":"Toda","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Keio University School of Medicine, Tokyo;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kazunari","family":"Yoshida","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Keio University School of Medicine, Tokyo;"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1754","reference":[{"key":"b1","series-title":"Ann Otol Rhinol Laryngol","doi-asserted-by":"publisher","first-page":"49","DOI":"10.1177\/000348946907800105","article-title":"Pneumatization of the temporal bone","volume":"78","author":"Allam AF","year":"1969","unstructured":"Allam AF: Pneumatization of the temporal bone. 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