J Rhinol.  2024 Mar;31(1):52-56. 10.18787/jr.2023.00076.

Two Cases of Cerebrospinal Fluid Rhinorrhea Repair Surgery Using TachoComb

• Bae AY
• Kim SH
• Hwang SH

• KMID: 2554092
• DOI: http://doi.org/10.18787/jr.2023.00076

Abstract

Cerebrospinal fluid (CSF) rhinorrhea is a rare condition characterized by the leakage of CSF through the nose. The diagnosis is established through comprehensive history taking, brain imaging, and nasal endoscopy. Surgical intervention is considered a secondary option for CSF leakage when conservative treatments, including behavioral therapy, pharmacotherapy, or lumbar puncture, fail to elicit a response. In recent years, endoscopic intranasal surgery has been favored over craniotomy for such surgical treatment. When repairing CSF leakage defects via endoscopic intranasal surgery, autologous fat and muscle flaps are commonly employed. However, these grafts may lead to complications, including donor site infection, edema, and wound dehiscence. Therefore, in this article, we would like to introduce two cases of CSF rhinorrhea repair surgery using TachoComb. While previous studies have employed TachoComb as a supplementary material for the repair of CSF leak defects, in the cases we describe, the primary reconstruction of the defect area was achieved using TachoComb, supported by free grafts such as septal bone or turbinate mucosal flap, which were smaller than the size of the CSF leakage defects.

Keyword

Cerebrospinal fluid leak; Pneumocephalus; TachoComb

Figure

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  Fig. 1. Paranasal sinus computed tomography, showing pneumocephalus and a suspicious bone defect at the posterior ethmoid air cell (Case 1).

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  Fig. 2. Intraoperative findings: Onodi cell posterior wall pinpoint perforation and active cerebrospinal fluid leakage were observed. Repair was performed using a nasal septal bone fragment and TachoComb (Case 1).

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  Fig. 3. Nasal endoscopy done on postoperative day 9. No discharge was seen at the left sphenoethmodial recess (Case 1).

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  Fig. 4. Brain computed tomography showing pneumocephalus in both frontal areas (Case 2).

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  Fig. 5. Intraoperative findings: dural damage at the right frontal base and cerebrospinal fluid leakage (Case 2).

Reference

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