ENDOSCOPIC TRANSNASAL REPAIR OF CEREBROSPINAL FLUID LEAKS IN THE AREA OF THE PARANASAL SINUSES AND CLIVUS

✍ Scribed by Stephen P. Becker; David D. Tieu; Gail Rosseau

• Publisher: John Wiley and Sons
• Year: 2010
• Tongue: English
• Weight: 906 KB
• Volume: 120
• Category: Article
• ISSN: 0023-852X
• DOI: 10.1002/lary.21704

✦ Synopsis

Conclusions

Methods Study Design: The patients were evaluated to be sure an active CSF leak was present using clinical exam including sinus endoscopy and radiologic techniques. Endoscopic repairs in association with microneurosurgical approaches were employed to close the leak. Still photographs will demonstrate the techniques. Methods: 5 patients who presented with CSF leaks between the years 2002-2009 were evaluated according to the etiology of the leak. An active CSF leak was confirmed in all patients and the site identified. A repair was planned using either vascularized septal mucosal flaps or free grafts of nasal mucosa. Preparation of the graft recipient site is important. A tissue glue either Tisseal or in the later cases Duraseal held the graft in place and assisted in sealing the leak. The patients were followed for 3 to 5 years to determine if the leak was successfully sealed. The transphenoidal approaches were all endoscopic with transfixion of the bony septum anterior to the anterior sphenoid wall and removal of the bony posterior septum and wide sphenoidotomy including resection of the sphenoid rostrum. Mucosa in this region was preserved for pedicled mucosal flaps.