Transantral repair of cerebrospinal fluid fistulas using bone chips, Tisseel, fascia and plaster of Paris.

Cerebrospinal rhinorrhea is a potentially serious symptom due to the risk of an ascending infection, which may produce a fulminant meningitis. Plaster of Paris has been used to obliterate the sphenoidal sinus and posterior ethmoids in five patients with cerebrospinal rhinorrhea. The fistulas were identified by computed cisternography and repaired by a transantral approach using a microsurgical technique, and bone chips, Tisseel and fascia to seal the fistulas. There have been no postoperative problems or leakage in the three patients with fistulas to the sphenoidal sinus. The cerebrospinal rhinorrhea recurred four and six months after operation in the two patients with fistulas to the posterior ethmoids probably due to surgical, technical problems in one patient and to less support by the plaster of Paris, when the fistulas end in this region. However, the described surgical technique seems to be a good alternative for fistulas to the sphenoidal sinus and should be included in our surgical armamentarium.