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Arch Otolaryngol Head Neck Surg. 2008 Nov;134(11):1187-90. doi: 10.1001/archotol.134.11.1187.

Sinus surgery in patients with previously repaired cerebrospinal fluid leaks.

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  • 1Department of Otolaryngology, Massachusetts Eye and EarInfirmary, Boston, USA.

Abstract

OBJECTIVE:

To explore surgical technique and outcomes of revision endoscopic sinus surgery (ESS) in patients with previously repaired cerebrospinal fluid (CSF) leaks.

DESIGN:

A case series of 13 patients with previously repaired iatrogenic CSF leaks who underwent revision ESS for recurrent sinus disease; a review of the preoperative workup, intraoperative findings, and postoperative outcomes.

SETTING:

Two academic medical centers.

PATIENTS:

Patients were included if they had a history of previously repaired skull base defect and iatrogenic CSF leak in the vicinity of the planned revision ESS.

INTERVENTIONS:

Revision ESS was performed in the vicinity of the previously repaired CSF leak. Dissection was carefully performed to avoid a recurrent CSF leak.

MAIN OUTCOME MEASURES:

Preoperative workup, intraoperative findings, surgical technique, and complications were reviewed.

RESULTS:

The study population consisted of 7 men and 6 women. Surgical navigation was used for all cases. Intrathecal fluorescein was not used in any case. In no instances was an active preexisting CSF leak identified or a new leak created. No minor or major postoperative complications arose in any of the study patients. All patients were discharged home within 24 hours. The mean (SD) follow-up was 26.0 (16.7) months.

CONCLUSIONS:

Previous skull base injury with CSF leak is not a contraindication to revision ESS. Safe ESS in this setting can be performed and may be recommended to such patients with symptomatic recurrence of their sinus disease.

[PubMed - indexed for MEDLINE]
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