Hostname: page-component-6766d58669-bp2c4 Total loading time: 0 Render date: 2026-05-20T20:04:10.973Z Has data issue: false hasContentIssue false
  • English
  • Français

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

Published online by Cambridge University Press:  25 August 2015

A S Taghi ,
M Bentley ,
R Kuchai  and
H A Saleh
A S Taghi*
Affiliation:
Department of Otolaryngology, Head and Neck Surgery, Charing Cross Hospital, London Imperial College Healthcare NHS Trust, UK
M Bentley
Affiliation:
Department of Otolaryngology, Head and Neck Surgery, Charing Cross Hospital, London Imperial College Healthcare NHS Trust, UK
R Kuchai
Affiliation:
Department of Otolaryngology, Head and Neck Surgery, Charing Cross Hospital, London Imperial College Healthcare NHS Trust, UK
H A Saleh
Affiliation:
Department of Otolaryngology, Head and Neck Surgery, Charing Cross Hospital, London Imperial College Healthcare NHS Trust, UK
*
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
Get access Rights & Permissions [Opens in a new window]

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.

Keywords

CSF RhinorrheaEustachian Tube

Information

Type
Clinical Records
Information
The Journal of Laryngology & Otology , Volume 129 , Issue 10 , October 2015 , pp. 1028 - 1031
Copyright
Copyright © JLO (1984) Limited 2015 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

Article purchase

Temporarily unavailable

References

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;24:107–12CrossRefGoogle ScholarPubMed
2Bryce, GE, Nedzelski, JM, Rowed, DW, Rappaport, JM. Cerebrospinal fluid leaks and meningitis in acoustic neuroma surgery. Otolaryngol Head Neck Surg 1991;104:81–7CrossRefGoogle ScholarPubMed
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;112:654–8CrossRefGoogle ScholarPubMed
4Hardy, DG, Macfarlane, R, Baguley, D, Moffat, DA. Surgery for acoustic neurinoma. An analysis of 100 translabyrinthine operations. J Neurosurg 1989;71:799–804CrossRefGoogle ScholarPubMed
5Kemink, JL, LaRouere, MJ, Kileny, PR, Telian, SA, Hoff, JT. Hearing preservation following suboccipital removal of acoustic neuromas. Laryngoscope 1990;100:597–602CrossRefGoogle ScholarPubMed
6Leonetti, J, Anderson, D, Marzo, S, Moynihan, G. Cerebrospinal fluid fistula after transtemporal skull base surgery. Otolaryngol Head Neck Surg 2001;124:511–14CrossRefGoogle ScholarPubMed
7Rodgers, GK, Luxford, WM. Factors affecting the development of cerebrospinal fluid leak and meningitis after translabyrinthine acoustic tumor surgery. Laryngoscope 1993;103:959–62CrossRefGoogle ScholarPubMed
8Selesnick, SH, Liu, JC, Jen, A, Newman, J. The incidence of cerebrospinal fluid leak after vestibular schwannoma surgery. Otol Neurotol 2004;25:387–93CrossRefGoogle ScholarPubMed
9Cueva, RA, Mastrodimos, B. Approach design and closure techniques to minimize cerebrospinal fluid leak after cerebellopontine angle tumor surgery. Otol Neurotol 2005;26:1176–81CrossRefGoogle ScholarPubMed
10Kwartler, JA, Schulder, M, Baredes, S, Chandrasekhar, SS. Endoscopic closure of the eustachian tube for repair of cerebrospinal fluid leak. Am J Otol 1996;17:470–2Google ScholarPubMed
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 39–40Google ScholarPubMed
12Orlandi, RR, Shelton, C. Endoscopic closure of the eustachian tube. Am J Rhinol 2004;18:363–5CrossRefGoogle ScholarPubMed
13Doherty, JK, Slattery, WH 3rd. Autologous fat grafting for the refractory patulous eustachian tube. Otolaryngol Head Neck Surg 2003;128:88–91CrossRefGoogle ScholarPubMed
14Hoffman, RA. Cerebrospinal fluid leak following acoustic neuroma removal. Laryngoscope 1994;104:40–58CrossRefGoogle ScholarPubMed
15Graf, CJ, Gross, CE, Beck, DW. Complications of spinal drainage in the management of cerebrospinal fluid fistula. J Neurosurg 1981;54:392–5CrossRefGoogle ScholarPubMed
16Roland, PS, Marple, BF, Meyerhoff, WL, Mickey, B. Complications of lumbar spinal fluid drainage. Otolaryngol Head Neck Surg 1992;107:564–9CrossRefGoogle ScholarPubMed
17Cox, JR. Hormonal influence on auditory function. Ear Hear 1980;1:219–22CrossRefGoogle ScholarPubMed
18Pulec, JL, Kamio, T, Graham, MD. Eustachian tube lymphatics. Ann Otol Rhinol Laryngol 1975;84:483–92CrossRefGoogle ScholarPubMed
19Pulec, JL, Simonton, KM. Abnormal patency of the eustachian tube: report on 41 cases. Laryngoscope 1964;74:267–71CrossRefGoogle ScholarPubMed
20O'Connor, AF, Shea, JJ. Autophony and the patulous eustachian tube. Laryngoscope 1981;91:1427–35CrossRefGoogle ScholarPubMed
21Ogawa, S, Satoh, I, Tanaka, H. Patulous eustachian tube. A new treatment with infusion of absorbable gelatin sponge solution. Arch Otolaryngol 1976;102:276–80CrossRefGoogle ScholarPubMed
22Pappada, G, Formaggio, G, Regalia, F, Panzarasa, G, Geuna, E. Course of intracranial pressure after extirpation of posterior fossa tumours. Acta Neurochir (Wien) 1984;70:11–19CrossRefGoogle ScholarPubMed