Transnasal Fluoroscopic-Guided Eustachian Tube Obliteration With a Liquid Embolic Agent for a Recurrent Cerebrospinal Fluid Leak After Translabyrinthine Schwannoma Surgery: A Case Series.

Abstract

Objective: Postoperative cerebrospinal fluid (CSF) leak after schwannoma surgery occurs in up to 10% of patients. Conventional surgical treatment including fat and muscle packing can prove unsuccessful. We describe a minimally invasive, imaging-guided approach to CSF fistula treatment.

Patients: We describe two patients and three procedures with recurrent CSF rhinorrhea after translabyrinthine vestibular or facial nerve schwannoma surgery. First-line procedures including CSF diversion and repeat middle ear packing failed to close the leaks.

Intervention: Endonasal endoscopic, fluoroscopic-guided obliteration of the Eustachian tube with n -butyl cyanoacrylate.

Main outcome measure: Recurrence of a CSF leak.

Results: After treatment, the CSF leak ceased with no recurrence. One patient's facial nerve dysfunction worsened after the procedure.

Conclusions: This case series highlights a recently described technique of imaging-guided Eustachian tube obliteration using liquid embolic agent. The procedure was effective in treating recurrent CSF leaks but might cause facial nerve dysfunction.