[First experiences in endonasal duraplasty without antibiotics]

Available evidence does not support the use of prophylactic antibiotics in patients with CSF fistulae. The question arises whether an antibiotic prophylaxis or therapy is mandatory planning an operative closure of frontobasal dural lesions.

In a retrospective survey a consecutive sample of 7 patients who had undergone endonasal ENT-department of two universities and an university teaching hospital was taken. The hospital course was evaluated and all patients were interviewed after a postoperative period between 6 and 36 months. Endonasal duraplasty by underlay or onlay technique without pre- or intraoperative application of antibiotics was performed. Hospital course, development of meningitis, need for antibiotic therapy later on, subjective complaints, history of meningitis, cerebrospinal fluid rhinorrhea, fluoresceine test (intrathecal administration of fluoresceine sodium and subsequent nasal endoscopy) were evaluated.

6 patients had an uneventful postoperative hospital course without any sign of inflammatory complications. In one patient with a larger resection of dura antibiotics were administered at the second postoperative day because of recurrent fever. There occurred no meningitis in any patient. All duraplasties were successfully closed. 5 patients showed a negative fluoresceine test, 2 patients denied it having no special problems.

Duraplasty can be performed satisfactorily by endonasal approach. In small lesions and in the absence of special risk factors (diabetes, acute sinusitis, immunodeficient patients) endonasal duraplasty don't seem to inevitably need an antibiotic cover. A larger patient population is necessary to confirm these results.