Cerebrospinal fluid fistula and endoscopic sinus surgery

Area of Science:

• Otolaryngology
• Neurosurgery
• Rhinology

Background:

• Cerebrospinal fluid (CSF) fistulae are rare but serious complications following endoscopic sinus surgery (ESS).
• Ethmoidectomy, a common ESS procedure, carries a risk of iatrogenic injury leading to CSF leakage.

Purpose of the Study:

• To analyze the incidence, location, and management of CSF fistulae after ESS.
• To evaluate the efficacy of endoscopic techniques in repairing CSF fistulae.

Main Methods:

• Retrospective review of 800 ethmoidectomies identifying 7 cases of CSF fistulae.
• Case consultation for 1 additional patient with CSF fistula.
• Classification of fistulae by location: intrasphenoid, posterior ethmoid/base of skull, anterior ethmoid, and ethmoid cribriform.
• Analysis of surgical repair methods: endoscopic closure, fibrin glue, Gelfoam, fascia, muscle, and conservative management.

Main Results:

• Eight CSF fistulae were identified (7 primary, 1 referred) following 800 ethmoidectomies.
• Fistulae locations varied, including intrasphenoid, posterior ethmoid/base of skull, anterior ethmoid, and ethmoid cribriform.
• Six of the eight fistulae were successfully closed using endoscopic techniques.
• Endoscopic repair with fibrin glue/Gelfoam and grafts (fascia, muscle) proved effective for most cases.

Conclusions:

• CSF fistulae are an uncommon complication of ESS, with diverse anatomical locations.
• Endoscopic surgical techniques offer a high success rate for repairing CSF fistulae, whether identified intraoperatively or delayed.
• Prompt diagnosis and endoscopic management are crucial for successful treatment of CSF fistulae post-ESS.