This study focuses on the diagnosis and management of a spontaneous cerebrospinal fluid leak (sCSF-L) through the facial nerve fallopian canal, emphasizing the significance of intracranial hypertension (IH) in these cases. A retrospective case study alongside a systematic literature review, adhering to PRISMA guidelines, was conducted. The case of a 50-year-old female with bilateral tegmen defects and temporal encephaloceles is highlighted. She underwent successful left middle cranial fossa (MCF) repair, with a novel approach of using a nonocclusive temporalis muscle plug for the fallopian canal CSF leak and bone cement for tegmen repair. Additionally, a ventriculoperitoneal shunt was placed to manage IH, resulting in preserved facial nerve function and normal hearing postoperatively.

The systematic review included 20 studies, encompassing 25 unique patients. Among adult cases of fallopian canal CSF leak, a 46% recurrence rate was noted, with 86% of patients exhibiting IH upon testing. The findings underscore the rarity and complexity of fallopian canal CSF leaks, recommending the assessment of IH and CSF diversion in conjunction with MCF skull base repair to maintain facial nerve function and hearing. This study contributes to the literature by highlighting the importance of considering IH in the management of sCSF-L through the facial nerve fallopian canal, offering a comprehensive approach to treatment.