Background Cerebrospinal fluid (CSF) leak after posterior fossa surgery is a well-known complication.
At times the leak occurs via the obliterated middle ear into the ET and is very challenging
to repair. Various approaches have been described for repair of CSF leak in lateral
skull base defects and the transcanal route is more commonly used for obliteration
of the ET. However, endoscopic transnasal access is also possible and we describe
the technique in two patients with CSF leak following resection of a lateral skull
base tumor. In both cases, the repair via a transnasal obliteration of the ET was
successful after one attempt.
Case Descriptions The first case is a 28-year-old woman who underwent temporal resection of a right
infratemporal fossa tumor with subsequent CSF leak from the right ET. She underwent
nasal endoscopy with obliteration of the ET using Cymetra. This led to cessation of
rhinorrhea over a 10-year follow-up period. The second case is a 31-year-old woman
who developed CSF rhinorrhea after translabyrinthine removal of vestibular schwannoma.
She also underwent nasal endoscopy to obliterate the ET using Surgicel, SurgiMend,
and Gelfoam packing in addition to a posteriorly based inferior turbinate mucoperiosteal
flap. A transoral approach was additionally used to allow for passage of suction Bovie
during the case. She has remained free of rhinorrhea over a 16-month follow-up period.
Discussion Few cases of endonasal obliteration of the ET have been described in the literature,
and in the reported cases, this method is reserved for recalcitrant cases of CSF rhinorrhea.
At times, obliteration of the ET via the middle ear is difficult and may disrupt the
repair of the defect. In this article, we present two successful cases of endonasal
closure of the ET as an initial intervention. This approach offers quick, safe, and
minimally invasive access to the eustachian tube, and it should be considered for
initial repair and not only for recalcitrant cases of postoperative CSF rhinorrhea.
