BATH-PLUG Technique in Case of Endoscopic Management of Cerebrospinal Fluid Rhinorrhea

In the past, the primary method for repairing cerebrospinal leaks was through craniotomy with intradural repair. However, in recent times, the popularity of transnasal repair via endoscopic sinus surgery has increased. This shift is mainly due to its lower morbidity and higher success rates. Nevertheless, the rise in iatrogenic CSF leaks has occurred as more surgeons adopt endoscopic sinus surgery. Therefore, caution must be exercised by endoscopic sinus surgeons when utilizing this technique. The objective of our study is to present a novel approach to endoscopic repair of CSF leaks. Herein, we present and discuss a case involving a 55-year-old woman with idiopathic CSF rhinorrhea accompanied by meningoencephalocele. Our technique involved the introduction of a specifically secured vicryl sutured fat plug into the intradural space, followed by applying traction on the suture to effectively seal the defect. This mechanism operates similarly to how a bath plug seals a bathtub. Importantly, our patient did not experience any intra- or post-operative complications. Furthermore, we did not utilize a lumbar drain or intra-thecal fluoresce in during the procedure.