Prevention of cerebrospinal fluid rhinorrhea in neurotologic surgery.
OBJECTIVE
To determine the efficacy and safety of quick-setting hydroxyapatite cement in eliminating cerebrospinal fluid (CSF) rhinorrhea following neurotologic surgery.


METHODS
A prospective study of 40 consecutive patients undergoing neurotologic surgery in whom the dura was opened.


METHODS
All patients were treated as hospital inpatients at a tertiary referral center.


METHODS
25 men and 15 women between the ages of 20 and 72 years (mean age 51 years) underwent neurotologic surgery at the parent institution.


METHODS
Various neurotologic procedures were performed for the resection of 25 acoustic tumors, 5 meningiomas, 3 glomus tumors, 2 vestibular nerve sections, 2 chordomas, 1 epidermoid tumor, and 1 meningoencephelocele, and for 2 patients referred to our institution with known CSF leaks following acoustic tumor surgery. A new form of quick-setting hydroxyapatite cement, which that hardens within 3 to 5 minutes was used to seal the air cell tracts of the temporal bone in all cases.


METHODS
The presence of CSF rhinorrhea postoperatively.


RESULTS
CSF rhinorrhea occurred in 2 patients following acoustic tumor surgery, the first through an occult air cell tract at the margin of the drilled internal auditory canal, and the second via an oval window fistula 1 month after a translabyrinthine approach.


CONCLUSIONS
This form of hydroxyapatite cement appears safe, reliable, effective, and economical for the prevention of CSF rhinorrhea following neurotologic surgery. CSF rhinorrhea cannot be eliminated unless our ability to identify all potential air cell tract communications improves.
Catalano
P J
PJ
Clinical Center for Cranial Base Surgery, Mount Sinai School of Medicine, New York, New York, USA.
Post
K
K
Sen
C
C
Costantino
P
P
Friedman
C
C
D000328:Adult; D000368:Aged; D001672:Biocompatible Materials / Q000627:therapeutic use; D002484:Cementation / Q000379:methods; D002559:Cerebrospinal Fluid Rhinorrhea / Q000517:prevention & control*; D017886:Durapatite / Q000627:therapeutic use; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009464:Neuroma, Acoustic / Q000000981:diagnostic imaging / Q000601:surgery; D013506:Otologic Surgical Procedures / Q000009:adverse effects*; D011183:Postoperative Complications / Q000517:prevention & control*; D011446:Prospective Studies; D011859:Radiography
D001672:Biocompatible Materials; D017886:Durapatite