Electroconvulsive Therapy Following Transmastoid Repair of a Skull-Base Defect and Cerebrospinal Fluid Leak

Electroconvulsive therapy (ECT) after skull-base reconstruction poses safety concerns related to potential elevations in intracranial pressure (ICP) and the risk of graft disruption. We report the case of a 61-year-old man with bipolar I depression who successfully underwent a course of right-unilateral brief-pulse ECT 7 weeks after transmastoid hydroxyapatite cement repair of a 1.5-cm tegmen mastoideum defect associated with cerebrospinal fluid (CSF) otorrhea. After initiation of ECT, the patient demonstrated marked clinical improvement [Montgomery-Åsberg Depression Rating Scale (MADRS) score reduced from 32 to 6 after 8 treatments], maintained stable cognition, and experienced no otologic or neurologic complications. This case illustrates that, with interdisciplinary collaboration and confirmation of postoperative graft integrity, ECT can be safely initiated in the early postoperative period after skull-base surgery.