Dear Editors,
Taghi et al. reported a technique for the treatment of refractory cerebrospinal fluid (CSF) rhinorrhoea after skull base surgery.Reference Taghi, Bentley, Kuchai and Saleh1 A patient underwent suboccipital craniotomy for decompression of a vascular loop from the Vth cranial nerve. In order to control post-operative CSF leakage and rhinorrhoea, middle cranial fossa craniotomy was performed.
Post-operative CSF leakage in this kind of surgery most commonly occurs via the opening of retrosigmoid or mastoid air cells, or through the nose via the eustachian tube.Reference Becker, Jackler and Pitts2 Therefore, middle cranial fossa craniotomy may not have been a good option for treating this complication.
The authors performed eustachian tube closure to treat the CSF fistula, and it was quite successful. However, by leaving the middle ear with no ventilation, there is a very high probability of atelectasis and possible cholesteatoma. Conductive hearing loss is inevitable, too.
The possible tract of the fistula can be found easily using a mastoid approach,Reference Millen and Meyer3 and the leak can be treated using a muscle plug. If no specific site is recognised, the mastoid can be obliterated to treat CSF leakage.
Eustachian tube closure seems to have high morbidity for such a patient, and there are better options for treatment.
