title: Cerebrospinal fluid leakage after endonasal dacryocystorhinostomy.
abstract: An endonasal dacryocystorhinostomy (DCR) was followed by cerebrospinal fluid leakage and pneumoencephalocele in an 80-year-old female patient presenting four independent risk factors for an ethmoidal breach: severe septal deviation requiring forced reclining, a cranial insertion of the perpendicular plate of the ethmoid directly onto the cribriform plate, meningeal prolapse, and extensive osteoporosis of the skull base. The use of a Killian valve speculum to recline the nasal septum was probably the main cause of the anterior skull base fracture. The defect was repaired by a composite patch of septal cartilage, abdominal fat grafts, Surgicel, and inferior turbinate mucosa. Thirty-four months after surgery, there was no residual symptom. A narrow nasal fossa makes endoscopic DCR more difficult to perform. The use of a Killian valve speculum to enlarge the nasal fossa may carry a risk for structural damage to the skull base. A narrow nasal fossa may require an external DCR or a prior endoscopic septoplasty to facilitate an endonasal approach. Closing an ethmoidal defect causing cerebrospinal fluid leakage can be successfully achieved by an endonasal approach rather than by a more conventional neurosurgical method.
authors.affiliation: Service d'Ophtalmologie, Hôpital de l'Hôtel Dieu de Paris, Paris, France.
authors.forename: B
authors.initials: B
authors.lastname: Fayet
authors.forename: E
authors.initials: E
authors.lastname: Racy
authors.forename: M
authors.initials: M
authors.lastname: Assouline
mesh_terms: D000369:Aged, 80 and over; D002559:Cerebrospinal Fluid Rhinorrhea / Q000209:etiology* / Q000503:physiopathology / Q000601:surgery*; D003608:Dacryocystorhinostomy / Q000009:adverse effects*; D005260:Female; D007839:Functional Laterality; D006801:Humans; D007765:Lacrimal Apparatus / Q000601:surgery*; D009078:Mucocele / Q000601:surgery*; D009300:Nasal Septum / Q000601:surgery; D011183:Postoperative Complications