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Cribriform CSF Leak: Endoscopic Surgical Repair Using Free Septal Mucosal Graft Without Postoperative Nasal Packs

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Abstract

Cribriform plate is the commonest site of Cerebrospinal fluid (CSF) leak, its fragility and juxtaposition of arachnoid’s investment to the bone, where the olfactory nerve pierces the skull, is a vulnerable site for CSF leak. Endoscopic transnasal approach has been the main stay for CSF leak repair over the past 2 decades. The technique and surgical steps of Endoscopic Surgical Repair of Cribriform CSF Leak using Free Septal Mucosal Graft without Postoperative Nasal packs are presented. Transnasal endoscopic CSF leak repair under General anesthesia with free mucosal graft, the critical steps include visualize the site of leak, lateralisation of middle turbinate, defect site cauterised with bipolar cautery. Free mucosal from contralateral side of the septum was placed as overlay technique. Graft stabilised with surgicel after ensuring adequate contact between the graft and the defect site. If the defect site is large then fat harvested from thigh is used as bath plug the defect, then free mucosal graft is kept supported by surgicel. Finally the middle turbinate was medialized and sutured with 3 0′ Vicryl with nasal septum to support the graft and also to stabilize the middle turbinate as a quilting stich. No fibrin glue was used in our case series. No nasal packing was done. Patients discharged on 2nd or 3rd postoperative day. This technique provides consistent good results reduced operating time of 40 min, no post-operative morbidity, early mobilisation, with 100% success rate and with added advantage of no nasal packing, patient can easily breathing through the nose postoperatively & no recurrence on long follow up.

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Acknowledgements

We would like to thank all patients who had undergone this procedure and had followed up timely, this encouraged us to share and submit this technique for publication in a scientific research journal.

Funding

Nil.

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Authors and Affiliations

  1. Ahilasamy ENT Centre, Chennai, Tamil Nadu, 600 042, India

    Nagalingeswaran Ahilasamy & Rajasekaran Sivaprakasam

  2. Department of ENT, Chengalpattu Medical College, Chengalpattu, Tamil Nadu, 603001, India

    Veerasigamani Narendrakumar

  3. Department of ENT and Head-Neck Surgery, Rajarajeshwari Medical College and Hospital, Bengaluru, Karnataka, 560074, India

    Dinesh Kumar Rajendran

Authors
  1. Nagalingeswaran Ahilasamy
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  2. Veerasigamani Narendrakumar
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  3. Dinesh Kumar Rajendran
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  4. Rajasekaran Sivaprakasam
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Contributions

NA, chief operating surgeon, provided substantial contributions to the conception of the work; acquired, analysed, and interpreted the data for the work; and remained a continuous source of inspiration, encouragement, and motivation for submission for publication. VN, the corresponding author for this article, drafted the work or revised it critically for important intellectual content and was involved in patient care and timely follow-up evaluator. DKR author was involved in final editing of the manuscript. RS contributed to preoperative and postoperative workup of the patients.

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Correspondence to Veerasigamani Narendrakumar.

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The authors declare that they have no competing interests.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Informed consent was obtained from all individual participants included in the study.

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Electronic supplementary material

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Left Sided CSF Leak Repair (MP4 29388 kb)

Rigth Sided CSF Leak Repair (MP4 26900 kb)

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Ahilasamy, N., Narendrakumar, V., Rajendran, D.K. et al. Cribriform CSF Leak: Endoscopic Surgical Repair Using Free Septal Mucosal Graft Without Postoperative Nasal Packs. Indian J Otolaryngol Head Neck Surg 73, 290–295 (2021). https://doi.org/10.1007/s12070-020-02107-1

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  • DOI: https://doi.org/10.1007/s12070-020-02107-1

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