Cribriform CSF Leak: Endoscopic Surgical Repair Using Free Septal Mucosal Graft Without Postoperative Nasal Packs
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ORIGINAL ARTICLE
Cribriform CSF Leak: Endoscopic Surgical Repair Using Free Septal Mucosal Graft Without Postoperative Nasal Packs Nagalingeswaran Ahilasamy1 • Veerasigamani Narendrakumar2 Dinesh Kumar Rajendran3 • Rajasekaran Sivaprakasam1
•
Received: 11 August 2020 / Accepted: 25 August 2020 Ó Association of Otolaryngologists of India 2020
Abstract Cribriform plate is the commonest site of Cerebrospinal fluid (CSF) leak, its fragility and juxtaposition of arachnoid’s investment to the bone, where the olfactory nerve pierces the skull, is a vulnerable site for CSF leak. Endoscopic transnasal approach has been the main stay for CSF leak repair over the past 2 decades. The technique and surgical steps of Endoscopic Surgical Repair of Cribriform CSF Leak using Free Septal Mucosal Graft without Postoperative Nasal packs are presented. Transnasal endoscopic CSF leak repair under General anesthesia with free mucosal graft, the critical steps include visualize the site of leak, lateralisation of middle turbinate, defect site cauterised with bipolar cautery. Free mucosal from contralateral side of the septum was placed as overlay technique. Graft stabilised with surgicel after ensuring adequate contact between the graft and the defect site. If the defect site
is large then fat harvested from thigh is used as bath plug the defect, then free mucosal graft is kept supported by surgicel. Finally the middle turbinate was medialized and sutured with 3 00 Vicryl with nasal septum to support the graft and also to stabilize the middle turbinate as a quilting stich. No fibrin glue was used in our case series. No nasal packing was done. Patients discharged on 2nd or 3rd postoperative day. This technique provides consistent good results reduced operating time of 40 min, no post-operative morbidity, early mobilisation, with 100% success rate and with added advantage of no nasal packing, patient can easily breathing through the nose postoperatively & no recurrence on long follow up. Keywords Cerebrospinal fluid CSF Rhinorrhoea Spontaneous Cribriform CSF leak Cerebrospinal fluid fistula Free mucosal graft No postoperative nasal packing
Electronic supplementary material The online version of this article (doi:https://doi.org/10.1007/s12070-020-02107-1) contains supplementary material, which is available to authorized users. & Veerasigamani Narendrakumar [email protected] Nagalingeswaran Ahilasamy [email protected] Dinesh Kumar Rajendran [email protected] Rajasekaran Sivaprakasam [email protected] 1
Ahilasamy ENT Centre, Chennai, Tamil Nadu 600 042, India
2
Department of ENT, Chengalpattu Medical College, Chengalpattu, Tamil Nadu 603001, India
3
Department of ENT and Head-Neck Surgery, Rajarajeshwari Medical College and Hospital, Bengaluru, Karnataka 560074, India
Introduction Cerebrospinal Fluid (CSF) rhinorrhoea is leakage of cerebrospinal fluid from the nose due to communication with subarachnoid space with disruption of dura along with bony defect [1]. Aetiology of CSF cribriform rhinorrhoe
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