Managing cerebrospinal fluid rhinorrhea after lateral skull base surgery via endoscopic endonasal eustachian tube closure.

Abstract

A cerebrospinal fluid (CSF) leak, commonly presenting as rhinorrhea, is a well-recognized complication of lateral skull base surgery. Failure of conservative treatment measures in these cases necessitates surgical intervention. Our aim is to demonstrate that endoscopic endonasal closure of the eustachian tube is a reasonable alternative to more traditional techniques for management of recalcitrant postoperative CSF rhinorrhea after removal of middle and posterior cranial fossa lesions. A retrospective chart review was performed for patients who presented with CSF rhinorrhea after lateral skull base surgery at a tertiary medical center over a 17-year period, from 1997 to 2014. Nine patients managed with endoscopic endonasal closure of the eustachian tube were evaluated for preoperative hearing status, approach to lateral skull base surgery, pathology, size and location of the tumor, timing and presentation of CSF leak, methods of treatment, length of hospital stay, complications, and success of the procedure. Of the nine patients included in this review, seven were managed successfully with endoscopic endonasal eustachian tube closure. Of those seven, one required a revision procedure. Average length of postoperative stay was 5.8 days. There were no major complications. Follow up of greater than 100 months has been achieved since the first procedure. Endoscopic endonasal eustachian tube closure is a safe, minimally invasive and effective method for obliteration of the eustachian tube orifice. The algorithm for management of recalcitrant postoperative CSF rhinorrhea after lateral skull base surgery should include endoscopic endonasal closure of the eustachian tube.