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Cerebrospinal fluid leakage after turbinate submucosal diathermy: an unusual complication.

ABSTRACT: Submucosal diathermy of the inferior turbinate (SMDIT) is a generally safe procedure to control inferior turbinate hypertrophy. We present a case of a cerebrospinal fluid (CSF) leak at the craniocervical junction after SMDIT done in another institution. A 27-year-old man presented 3 weeks after undergoing SMDIT with signs and symptoms of meningitis and postnasal rhinorrhea. Nasal endoscopy and imaging revealed a nasopharyngeal CSF fistula at the craniocervical junction. Transnasal endoscopic repair and reconstruction was performed with no recurrence on repeat imaging and clinical follow up. We describe the first reported case in the literature of an iatrogenic CSF fistula caused by SMDIT, an unusual and potentially fatal complication, and its surgical management.0None.

SUBMITTER: Abobotain AH

PROVIDER: S-EPMC6074370 | biostudies-other | 2018 Mar-Apr

REPOSITORIES: biostudies-other

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Cerebrospinal fluid leakage after turbinate submucosal diathermy: an unusual complication.

Abobotain Abdulaziz H AH Ajlan Abdulrazag A Alsaleh Saad S

Annals of Saudi medicine 20180301 2

Submucosal diathermy of the inferior turbinate (SMDIT) is a generally safe procedure to control inferior turbinate hypertrophy. We present a case of a cerebrospinal fluid (CSF) leak at the craniocervical junction after SMDIT done in another institution. A 27-year-old man presented 3 weeks after undergoing SMDIT with signs and symptoms of meningitis and postnasal rhinorrhea. Nasal endoscopy and imaging revealed a nasopharyngeal CSF fistula at the craniocervical junction. Transnasal endoscopic rep ...[more]

PMID: 29620550

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Project description:BackgroundDespite improvements in closure techniques by using a vital nasoseptal flap, the use of sealing materials, and improved neurosurgical techniques, cerebrospinal fluid (CSF) leak after transsphenoidal surgery still is a clinically relevant problem. Liqoseal® (Polyganics bv, Groningen, The Netherlands) is a CE-approved bioresorbable sealant patch for use as an adjunct to standard methods of cranial dural closure to prevent CSF leakage. This study aims to evaluate the application of Liqoseal in transsphenoidal surgery ex vivo and in vivo.Methods1. We created an ex vivo setup simulating the sphenoidal anatomy, using a fluid pump and porcine dura positioned on a conus with the anatomical dimensions of the sella to evaluate whether the burst pressure of Liqoseal applied to a bulging surface was above physiological intracranial pressure. Burst pressure was measured with a probe connected to dedicated computer software. Because of the challenging transsphenoidal environment, we tested in 4 groups with varying compression weight and time for the application of Liqoseal. 2. We subsequently describe the application of Liqoseal® in 3 patients during transsphenoidal procedures with intraoperative CSF leakage to prevent postoperative CSF leakage.Results1. Ex vivo: The overall mean burst pressure in the transsphenoidal setup was 231 (± 103) mmHg. There was no significant difference in mean burst pressure between groups based on application weight and time (p = 0.227). 2. In Vivo: None of the patients had a postoperative CSF leak. No nose passage problems were observed. One patient had a postoperative meningitis and ventriculitis, most likely related to preoperative extensive CSF leakage. Postoperative imaging did not show any local infection, swelling, or other device-related adverse effects.ConclusionsWe assess the use of Liqoseal® to seal a dural defect during an endoscopic transsphenoidal procedure as to be likely safe and potentially effective.

Dataset Information

Cerebrospinal fluid leakage after turbinate submucosal diathermy: an unusual complication.

Publications

Cerebrospinal fluid leakage after turbinate submucosal diathermy: an unusual complication.

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