![]() 3, 21 The eustachian tube (ET) is the final common pathway associated with these lateral skull base surgical approaches and the most common route for CSF leakage presenting as CSF rhinorrhea. ![]() 1 Indeed, CSF leakage is the most common complication of vestibular schwannoma resection, 2 but it can also be observed in trauma, neoplasms, and congenital malformations. The summaries and technical notes described in this paper may serve as a resource for those skull base teams faced with similar challenging and otherwise refractory CSF leaks from a lateral skull base source.Ĭ erebrospinal fluid (CSF) leaks occur in approximately 10% of patients undergoing a translabyrinthine approach, retrosigmoid craniectomy, or middle fossa approach for vestibular schwannoma resection, 19 with no significant difference in the incidence of leaks among these approaches. Additional studies are warranted to further demonstrate the outcome and cost-saving benefits of EEETO as the data until now have been largely empirical yet very hopeful. It can be readily implemented into algorithms once CSF diversion (for example, lumbar drain) has failed, prior to considering open surgery for repair. By its minimally invasive nature, EEETO imposes less morbidity as well as less risk to the patient. They further summarize the literature regarding studies that describe various iterations of EEETO. ![]() They present a case in which EEETO resolved refractory CSF rhinorrhea over a 10-month follow-up after CSF diversions, wound reexploration, revised packing of the ET via a lateral microscopic translabyrinthine approach, and the use of a vascularized flap had failed. Given the results of their analysis, they recommend endoscopic endonasal ET obliteration (EEETO) as a first- or second-line technique for the repair of CSF rhinorrhea from a lateral skull base source refractory to spontaneous healing and CSF diversion. In this case-based theoretical analysis, the authors summarize the literature regarding endoscopic endonasal techniques to obliterate the eustachian tube (ET) as well as compare endoscopic endonasal versus open approaches for repair. This can not only lead to morbidity but is also costly and burdensome to the health care system. A high degree of difficulty in repair sometimes requires repetitive microsurgical revisions-a rate of 10% of cases is often cited. Cerebrospinal fluid rhinorrhea also results from trauma, neoplasms, and congenital defects. Cerebrospinal fluid (CSF) leaks occur in approximately 10% of patients undergoing a translabyrinthine, retrosigmoid, or middle fossa approach for vestibular schwannoma resection.
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