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Image Guided, Endoscopic Repair of CSF Rhinorrhea Using a Superiorly Based, Middle Turbinate Rotational Flap

Erik Berg, MD, Elie Rebeiz, MD, FACS
Tufts Medical Center- Department of Otolaryngology ; Boston, MA


PURPOSE OF STUDY
1. Understand the background on CSF rhinorrhea and treatment options
2. Explain steps of image guided, endoscopic surgical technique with middle turbinate rotational flap
3. Review outcomes of patients in case series
4. Recognize this surgical technique is a safe and effective method for treating CSF rhinorrhea

METHODS USED:
Case series of 18 cases of CSF rhinorrhea at Tufts Medical Center that were surgically treated with image guided, endoscopic repair using a middle turbinate rotational flap. Review of the charts for patients undergoing the surgical repair and the outcome. All patient underwent CT guidance via BrainLab, intrathecal fuorescein with exploration of middle & superior meati and nasopharynx, an ethmoidectomy and/or sphenoidotomy and de-epithelialization of the defectís edges. Septal cartilage was harvested for free graft, and the medial aspect of the middle turbinate was de-epithelialized posteriorly, and rotated superiorly (Superiorly based flap). Fibrin glue, and packing was used in all cases and is described in details.

SUMMARY OF RESULTS:
Results: Review of charts and data on outcomes of 18 cases for effectiveness of surgical technique and complications. There were no recurrences and no need for further surgical procedures. Additionally, there were no complications of meningitis, flap failure, or other iatrogenic injuries.

CONCLUSIONS:
Image Guided, Endoscopic CSF Leak Repair with Middle Turbinate Rotational Flap is a safe and effective method of repairing CSF leaks, with no recurrences and little to no morbidity in our case series.

 

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