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Published on: February 29, 2020
Bath-plug technique for the endoscopic management of cerebrospinal fluid leaks in children
Xiaojian Yang1, Lixing Tang1, Pengpeng Wang1
1Department of Otorhinolaryngology, Head and Neck Surgery Beijing Children's Hospital Capital Medical University National Center for Children's Health Beijing China.
Insights
The bath-plug technique safely and effectively closes cerebrospinal fluid (CSF) leaks in children. This endoscopic method is reliable for pediatric CSF leak repair, with no complications reported in a recent study.
Area of Science:
- Neurosurgery
- Pediatric Surgery
- Otolaryngology
Background:
- Cerebrospinal fluid (CSF) leaks pose significant challenges in pediatric patients.
- The safety and efficacy of the bath-plug technique for pediatric CSF leak closure were previously undetermined.
Purpose of the Study:
- To evaluate the safety and effectiveness of the bath-plug technique for endoscopic repair of CSF leaks in children.
Main Methods:
- Retrospective review of 18 pediatric patients undergoing endoscopic CSF leak repair using the bath-plug technique.
- Analysis of demographic data, defect characteristics, interventions, and clinical outcomes.
- Inclusion of a representative case to illustrate the procedure and healing.
Main Results:
- All 18 pediatric patients (11 boys, 7 girls; age 5-123 months) achieved successful CSF leak repair.
- Common leak sites included the cribriform plate (66.7%). Encephalocele was present in 77.8% of patients.
- No surgical complications were observed during a follow-up of 50-70 months.
Conclusions:
- The bath-plug technique is a safe and reliable endoscopic approach for managing pediatric CSF leaks.
- Careful peri-operative preparation is crucial for successful outcomes in pediatric patients.
Importance:
The safety and efficacy of the bath-plug technique for the closure of cerebrospinal fluid (CSF) leaks in children remain unknown.
Objective:
We undertook this study to ascertain whether the bath-plug technique was safe and effective for the repair of CSF leaks.
Methods:
We retrospectively reviewed patients who underwent endoscopic repair of CSF leaks with the fat graft as a plug-in at Beijing Children's Hospital from March 2016 to May 2020. Demographic data, medical history, defect sites and sizes, interventions, and clinical outcomes were analyzed. One representative clinical case was additionally selected to highlight the procedure and the healing process.
Results:
A total of 18 pediatric patients were included in this study. The group was composed of 11 boys and seven girls, aged from 5 to 123 months. The etiologies included congenital CSF leaks (n = 9) and head trauma (n = 9). Among all patients, 12 fistulas (66.7%) were located at the cribriform plate area, two (11.1%) at the roof of the ethmoid sinuses, two (11.1%) in the sphenoid sinus, and two (11.1%) at the frontal sinus. The maximum diameters of fistulas ranged from 5 to 20 mm, with a median value of 8 mm. Encephaloceles were identified in 14 (77.8%) patients. No hydrocephalus was recognized. All CSF leaks were successfully repaired with a bath-plug technique. Follow-up ranged from 50 to 70 months. No surgical complications were encountered in any patient.
Interpretation:
Bath-plug technique is safe and reliable for the endoscopic management of CSF leaks in children. Meticulous peri-operative preparations are important for pediatric patients.
