Abstract
BACKGROUNDRhinorrhea due to lateral skull base cerebrospinal fluid (CSF) leaks can be a challenge to manage. Multiple strategies exist for treating CSF leaks in this region including direct repair, posterior Eustachian tube packing, and CSF diversion. Endonasal closure of the Eustachian tube has been reported using cerclage and mucosal flaps.OBSERVATIONSWe present the first reported case of endoscopic autologous fat packing of the Eustachian tube orifice to repair a CSF leak. In this case a 42-year-old woman who underwent middle fossa meningioma resection 20 years ago presented with refractory CSF rhinorrhea despite blind sac closure of the ear canal. This persisted after CSF diversion and only resolved after endoscopic endonasal Eustachian tube closure described herein.LESSONSThis technique is simple to perform with minimal risk of morbidity. Eustachian tube orifice fat packing may be particularly useful for patients with refractory CSF rhinorrhea with low CSF pressure.
Highlights
Rhinorrhea due to lateral skull base cerebrospinal fluid (CSF) leaks can be a challenge to manage
Observations CSF leak is a significant potential morbidity of lateral skull base surgery, when it results in meningitis
A leak may manifest as rhinorrhea, as CSF drains through the middle ear to the Eustachian tube into the nasopharynx
Summary
Rhinorrhea due to lateral skull base cerebrospinal fluid (CSF) leaks can be a challenge to manage. OBSERVATIONS We present the first reported case of endoscopic autologous fat packing of the Eustachian tube orifice to repair a CSF leak In this case a 42-year-old woman who underwent middle fossa meningioma resection 20 years ago presented with refractory CSF rhinorrhea despite blind sac closure of the ear canal. This persisted after CSF diversion and only resolved after endoscopic endonasal Eustachian tube closure described . Recalcitrant lateral skull base cerebrospinal fluid (CSF) leaks can be difficult to manage Such leaks are repaired from a lateral approach, including direct repair or by blind sac closure of the external auditory canal and Eustachian tube packing via the middle ear space. We present the first report of endoscopic autologous fat grafting of the Eustachian tube orifice for repair of a CSF leak
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