ENDOSCOPIC CLOSURE OF THE EUSTACHIAN-TUBE FOR REPAIR OF CEREBROSPINAL-FLUID LEAK

Techniques to repair cerebrospinal fluid (CSF) leak through the eustac hian tube (ET) include temporary or permanent CSF diversion; middle fo ssa craniotomy and packing of the ET from above; and packing of the ET from behind through the middle ear. We report a case of endoscopic cl osure of the ET in the nasopharynx (the front). A 26-year-old woman un derwent a translabyrinthine removal of a 4.5-cm vestibular schwannoma. One year later, she developed CSF rhinorrhea and meningitis. Attempts at control of this leak included traditional approaches mentioned pre viously (shunting, middle fossa, middle ear packing). The leak recurre d 2-3 months after reach procedure. An endoscope was used transnasally to expose the ET orifice, which was incised, inverted, and cauterized . She has remained free of leak for 1 year. Our success in this diffic ult case suggests that this is a useful procedure for treatment of CSF rhinorrhea originating in the posterior fossa. Greater experience is needed to verify its long-term effectiveness and utility as a primary procedure for the treatment of CSF rhinorrhea.