title: Endoscopic management of cerebrospinal fluid leak associated with the use of bone wax in skull-base surgery.
abstract: OBJECTIVE
  To alert otolaryngologists to consider the possibility that bone wax may be associated with cerebrospinal fluid leaks that occur immediately after skull-base craniotomy approaches.
  
  
  METHODS
  Clinical report from surgical experience in a tertiary care setting.
  
  
  RESULTS
  Three patients presented with brisk cerebrospinal fluid leak after craniotomy. Sinus endoscopy revealed bone wax within a small parasphenoid defect in all 3 cases.
  
  
  CONCLUSIONS
  Bleeding from areas of the skull base adjacent to the paranasal sinuses during craniotomy can signal a small breach of the skull base. Bone wax may control bleeding from edges of transected bone but also stent the skull-base defect open, preventing fibrin deposition and spontaneous healing and closure.
  
  
  CONCLUSIONS
  Otolaryngologists repairing a cerebrospinal fluid leak after a skull-base craniotomy approach should consider the possibility of encountering bone wax and be able to identify it to better treat their patient.
authors.affiliation: Division of Otolaryngology, Uniformed Services University of the Health Sciences, Bethesda, MD, USA. wbolger@usuhs.mil
authors.forename: William E
authors.initials: WE
authors.lastname: Bolger
authors.forename: Monica
authors.initials: M
authors.lastname: Tadros
authors.forename: Richard G
authors.initials: RG
authors.lastname: Ellenbogen
authors.forename: Kevin
authors.initials: K
authors.lastname: Judy
authors.forename: M Sean
authors.initials: MS
authors.lastname: Grady
mesh_terms: D000328:Adult; D002555:Cerebrospinal Fluid; D003399:Craniotomy / Q000009:adverse effects*; D004338:Drug Combinations; D004724:Endoscopy; D005260:Female; D006490:Hemostatics / Q000009:adverse effects*; D006801:Humans; D010168:Palmitates / Q000009:adverse effects*; D011183:Postoperative Complications / Q000628:therapy*; D014885:Waxes / Q000009:adverse effects*
chemical_list: D004338:Drug Combinations; D006490:Hemostatics; D010168:Palmitates; D014885:Waxes; C055480:bone wax