Trans-canal Endoscopic Repair of Cerebrospinal Fluid (CSF) Leak following Vestibular Schwannoma Resection

By June 7, 2019

Manzoor N.F.1; Rivas, A.1
1 Department of Otolaryngology-Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, TN, USA.

CSF leak presenting as rhinorrhea following surgical resection of vestibular schwannoma usually fails conservative measures. It most often needs operative intervention aimed at the middle ear and mastoid obliteration as well as procedures aimed at packing of the eustachian tube. Here we describe a case of low volume delayed CSF leak following a retro-sigmoid craniotomy which was successfully repaired using a TEES approach directed at the infra-cochlear region and eustachian tube.

Study design: Case report
Setting: Tertiary otology-neurotology referral center
Patient: 68-year-old male who presented with low volume CSF leak (rhinorrhea) after a retro-sigmoid approach for resection of vestibular schwannoma.
Intervention: TEES for repair of CSF leak

The leak was emanating from the infra-cochlear tract. This was accessed with partial drill-out of the infra-cochlear tract and then obliterated with muscle and Surgicel (oxidized cellulose, Ethicon Inc.). Eustachian tube orifice was also obliterated with the same materials. All middle ear structures were otherwise preserved. Cartilage and perichondrium graft was also used to reinforce the reconstruction inferiorly. There was no recurrent CSF leak. No peri-operative CSF diversion was used and the patient was discharged on the same day.

TEES approach can be used for definitive repair of CSF leak complication lateral skull base procedures with careful selection of cases.