title: Sinus surgery in patients with previously repaired cerebrospinal fluid leaks.
abstract: OBJECTIVE
  To explore surgical technique and outcomes of revision endoscopic sinus surgery (ESS) in patients with previously repaired cerebrospinal fluid (CSF) leaks.
  
  
  METHODS
  A case series of 13 patients with previously repaired iatrogenic CSF leaks who underwent revision ESS for recurrent sinus disease; a review of the preoperative workup, intraoperative findings, and postoperative outcomes.
  
  
  METHODS
  Two academic medical centers.
  
  
  METHODS
  Patients were included if they had a history of previously repaired skull base defect and iatrogenic CSF leak in the vicinity of the planned revision ESS.
  
  
  METHODS
  Revision ESS was performed in the vicinity of the previously repaired CSF leak. Dissection was carefully performed to avoid a recurrent CSF leak.
  
  
  METHODS
  Preoperative workup, intraoperative findings, surgical technique, and complications were reviewed.
  
  
  RESULTS
  The study population consisted of 7 men and 6 women. Surgical navigation was used for all cases. Intrathecal fluorescein was not used in any case. In no instances was an active preexisting CSF leak identified or a new leak created. No minor or major postoperative complications arose in any of the study patients. All patients were discharged home within 24 hours. The mean (SD) follow-up was 26.0 (16.7) months.
  
  
  CONCLUSIONS
  Previous skull base injury with CSF leak is not a contraindication to revision ESS. Safe ESS in this setting can be performed and may be recommended to such patients with symptomatic recurrence of their sinus disease.
authors.affiliation: Department of Otolaryngology, Massachusetts Eye and EarInfirmary, Boston, USA.
authors.forename: Douglas D
authors.initials: DD
authors.lastname: Reh
authors.forename: Ralph
authors.initials: R
authors.lastname: Metson
authors.forename: Raj
authors.initials: R
authors.lastname: Sindwani
mesh_terms: D000328:Adult; D002559:Cerebrospinal Fluid Rhinorrhea / Q000175:diagnosis / Q000601:surgery*; D002908:Chronic Disease; D004724:Endoscopy; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009298:Nasal Polyps / Q000175:diagnosis / Q000601:surgery; D011183:Postoperative Complications / Q000175:diagnosis / Q000601:surgery*; D012008:Recurrence; D012086:Reoperation; D012189:Retrospective Studies; D012220:Rhinitis / Q000601:surgery*; D012852:Sinusitis / Q000601:surgery*; D019291:Skull Base / Q000601:surgery; D025321:Surgery, Computer-Assisted; D000267:Tissue Adhesions / Q000175:diagnosis / Q000601:surgery; D014057:Tomography, X-Ray Computed