Abstract
Purpose:
Cerebrospinal fluid (CSF) rhinorrhea is a complication of lateral skull base surgery necessitating closure of the eustachian tube (ET). Endoscopic endonasal closure of the ET can be incorporated in the algorithm for management of recalcitrant postoperative CSF leak after internal auditory canal (IAC) and cerebellopontine angle (CPA) tumor removal.
Method:
Retrospective chart review was performed for patients who presented with CSF rhinorrhea after resection of vestibular schwannoma to the University of Miami between 1997 and 2009, and were then managed with endoscopic endonasal closure of eustachian tube.
Results:
Four out of five patients with recalcitrant postoperative CSF rhinorrhea were managed successfully with endoscopic endonasal eustachian tube closure. Two tumor resections were performed via a translabyrinthine approach; one had a retrosigmoid approach; one was suboccipital; and one had a middle cranial fossa approach, which did not preserve hearing. Three patients presented with delayed CSF leaks while the two translabyrinthine approaches presented with immediate perioperative leak. The mean follow-up was 44 months. The average hospital stay after surgery was 3.5 days. There were no complications.
Conclusion:
Endoscopic endonasal closure of the eustachian tube is a safe, minimally invasive, and effective method to obliterate the eustachian tube orifice. The algorithm for management of recalcitrant postoperative CSF leak after acoustic tumor surgery should include endoscopic endonasal closure of the eustachian tube.