Skip to main content Accessibility help
×
×
Home

Double seal technique to obliterate the eustachian tube orifice: a novel method for the treatment of recalcitrant cerebrospinal fluid leak

  • A S Taghi (a1), M Bentley (a1), R Kuchai (a1) and H A Saleh (a1)

Abstract

Objective:

To demonstrate a novel and effective surgical technique for the treatment of refractory cerebrospinal fluid rhinorrhoea after skull base surgery. The novel surgical technique is described and the findings of a review of relevant world English-language publications are reported.

Case report:

A 44-year-old woman, otherwise fit and well, presented with more than a 2-year history of right-sided facial pain. A diagnosis of classical trigeminal neuralgia was made. Surgical treatment was undertaken with a retromastoid suboccipital craniotomy. Post-operatively, the patient showed signs of right-sided cerebrospinal fluid rhinorrhoea which was recalcitrant. In light of a continuous leak and several hospital admissions, a novel technique was performed whereby the eustachian tube orifice was obliterated using an endonasal endoscopic approach. The technique proved to be successful, with no further leakage.

Conclusion:

Endoscopic obliteration of the eustachian tube using a double seal technique is a simple, safe and effective procedure in the treatment of a refractory cerebrospinal fluid leak.

Copyright

Corresponding author

Address for correspondence: Mr Ali S Taghi, Department of Otolaryngology, Head and Neck Surgery, Charing Cross Hospital, Imperial College Healthcare NHS Trust, London W6 8RF, UK E-mail: ali@taghi.org.uk

References

Hide All
1Becker, SS, Jackler, RK, Pitts, LH. Cerebrospinal fluid leak after acoustic neuroma surgery: a comparison of the translabyrinthine, middle fossa, and retrosigmoid approaches. Otol Neurotol 2003;24:107–12
2Bryce, GE, Nedzelski, JM, Rowed, DW, Rappaport, JM. Cerebrospinal fluid leaks and meningitis in acoustic neuroma surgery. Otolaryngol Head Neck Surg 1991;104:81–7
3Celikkanat, SM, Saleh, E, Khashaba, A, Taibah, A, Russo, A, Mazzoni, A et al. Cerebrospinal fluid leak after translabyrinthine acoustic neuroma surgery. Otolaryngol Head Neck Surg 1995;112:654–8
4Hardy, DG, Macfarlane, R, Baguley, D, Moffat, DA. Surgery for acoustic neurinoma. An analysis of 100 translabyrinthine operations. J Neurosurg 1989;71:799804
5Kemink, JL, LaRouere, MJ, Kileny, PR, Telian, SA, Hoff, JT. Hearing preservation following suboccipital removal of acoustic neuromas. Laryngoscope 1990;100:597602
6Leonetti, J, Anderson, D, Marzo, S, Moynihan, G. Cerebrospinal fluid fistula after transtemporal skull base surgery. Otolaryngol Head Neck Surg 2001;124:511–14
7Rodgers, GK, Luxford, WM. Factors affecting the development of cerebrospinal fluid leak and meningitis after translabyrinthine acoustic tumor surgery. Laryngoscope 1993;103:959–62
8Selesnick, SH, Liu, JC, Jen, A, Newman, J. The incidence of cerebrospinal fluid leak after vestibular schwannoma surgery. Otol Neurotol 2004;25:387–93
9Cueva, RA, Mastrodimos, B. Approach design and closure techniques to minimize cerebrospinal fluid leak after cerebellopontine angle tumor surgery. Otol Neurotol 2005;26:1176–81
10Kwartler, JA, Schulder, M, Baredes, S, Chandrasekhar, SS. Endoscopic closure of the eustachian tube for repair of cerebrospinal fluid leak. Am J Otol 1996;17:470–2
11Friedman, RA, Cullen, RD, Ulis, J, Brackmann, DE. Management of cerebrospinal fluid leaks after acoustic tumor removal. Neurosurgery 2007;61(3 suppl):35–9; discussion 39–40
12Orlandi, RR, Shelton, C. Endoscopic closure of the eustachian tube. Am J Rhinol 2004;18:363–5
13Doherty, JK, Slattery, WH 3rd. Autologous fat grafting for the refractory patulous eustachian tube. Otolaryngol Head Neck Surg 2003;128:8891
14Hoffman, RA. Cerebrospinal fluid leak following acoustic neuroma removal. Laryngoscope 1994;104:4058
15Graf, CJ, Gross, CE, Beck, DW. Complications of spinal drainage in the management of cerebrospinal fluid fistula. J Neurosurg 1981;54:392–5
16Roland, PS, Marple, BF, Meyerhoff, WL, Mickey, B. Complications of lumbar spinal fluid drainage. Otolaryngol Head Neck Surg 1992;107:564–9
17Cox, JR. Hormonal influence on auditory function. Ear Hear 1980;1:219–22
18Pulec, JL, Kamio, T, Graham, MD. Eustachian tube lymphatics. Ann Otol Rhinol Laryngol 1975;84:483–92
19Pulec, JL, Simonton, KM. Abnormal patency of the eustachian tube: report on 41 cases. Laryngoscope 1964;74:267–71
20O'Connor, AF, Shea, JJ. Autophony and the patulous eustachian tube. Laryngoscope 1981;91:1427–35
21Ogawa, S, Satoh, I, Tanaka, H. Patulous eustachian tube. A new treatment with infusion of absorbable gelatin sponge solution. Arch Otolaryngol 1976;102:276–80
22Pappada, G, Formaggio, G, Regalia, F, Panzarasa, G, Geuna, E. Course of intracranial pressure after extirpation of posterior fossa tumours. Acta Neurochir (Wien) 1984;70:1119
Recommend this journal

Email your librarian or administrator to recommend adding this journal to your organisation's collection.

The Journal of Laryngology & Otology
  • ISSN: 0022-2151
  • EISSN: 1748-5460
  • URL: /core/journals/journal-of-laryngology-and-otology
Please enter your name
Please enter a valid email address
Who would you like to send this to? *
×

Keywords

Metrics

Altmetric attention score

Full text views

Total number of HTML views: 0
Total number of PDF views: 0 *
Loading metrics...

Abstract views

Total abstract views: 0 *
Loading metrics...

* Views captured on Cambridge Core between <date>. This data will be updated every 24 hours.

Usage data cannot currently be displayed