Management of unexpected cerebrospinal fluid fistulae during endoscopic sinus surgery.
BACKGROUND
The aim of this study was to determine the incidence and perioperative management of patients with cerebrospinal fluid (CSF) fistulas during endoscopic sinus surgery (ESS) in New York State.


METHODS
A questionnaire was mailed to otolaryngologists in New York State who were registered with the American Academy of Otolaryngology, Head and Neck Surgery in November 2005. Questions addressed the incidence and perioperative care of patients with successful closure of unexpected CSF fistula during ESS.


RESULTS
Twenty-five percent of respondents have experienced at least one episode of unexpected CSF fistula during ESS over the prior 5 years, with a calculated incidence of 0.16%. Surgeons most often (46%) observed patients for 1-2 days. Antibiotics were used in 93% of patients. A lumbar drain was most commonly not used. Repair techniques most often used an intranasal flap or graft (92%).


CONCLUSIONS
The incidence of unexpected CSF fistula during ESS may be lower than previously reported. A majority of surgeons use an intranasal flap or graft in repair with antibiotic use, with no consensus regarding use of lumbar drain or inpatient observation. More study is needed to determine consensus algorithms for management of CSF leaks during ESS.
Platt
Michael P
MP
Division of Otolaryngology, Albany Medical College, Albany, New York, USA.
Shaye
David
D
Parnes
Steven M
SM
D002555:Cerebrospinal Fluid / Q000737:chemistry*; D002558:Cerebrospinal Fluid Otorrhea / Q000209:etiology / Q000517:prevention & control*; D004724:Endoscopy / Q000009:adverse effects* / Q000379:methods*; D005402:Fistula / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D006801:Humans; D009296:Nasal Cavity / Q000601:surgery*; D010036:Otolaryngology / Q000295:instrumentation / Q000379:methods*; D013517:Otorhinolaryngologic Surgical Procedures / Q000379:methods; D011183:Postoperative Complications / Q000209:etiology / Q000517:prevention & control*; D011859:Radiography; D015203:Reproducibility of Results; D011795:Surveys and Questionnaires; D013997:Time Factors