Double seal technique to obliterate the eustachian tube orifice: a novel method for the treatment of recalcitrant cerebrospinal fluid leak.

OBJECTIVE

To demonstrate a novel and effective surgical technique for the treatment of refractory cerebrospinal fluid rhinorrhoea after skull base surgery. The novel surgical technique is described and the findings of a review of relevant world English-language publications are reported.

CASE REPORT: A 44-year-old woman, otherwise fit and well, presented with more than a 2-year history of right-sided facial pain. A diagnosis of classical trigeminal neuralgia was made. Surgical treatment was undertaken with a retromastoid suboccipital craniotomy. Post-operatively, the patient showed signs of right-sided cerebrospinal fluid rhinorrhoea which was recalcitrant. In light of a continuous leak and several hospital admissions, a novel technique was performed whereby the eustachian tube orifice was obliterated using an endonasal endoscopic approach. The technique proved to be successful, with no further leakage.

CONCLUSION

Endoscopic obliteration of the eustachian tube using a double seal technique is a simple, safe and effective procedure in the treatment of a refractory cerebrospinal fluid leak.