Endoscopic Endonasal Eustachian Tube Obliteration for Cerebrospinal Fluid Rhinorrhea: A Case Series and Scoping Review

Abstract

BACKGROUND: Endoscopic endonasal eustachian tube obliteration (EEETO) is a valuable option for treating cerebrospinal fluid rhinorrhea (CSFR) after lateral skull base surgery. Several small case series describe different techniques because of the rarity of this indication. OBJECTIVE: To review available literature on EEETO focusing on technique and factors affecting success. We also contribute a new case series using a knotless barbed suture technique. METHODS: This was a retrospective chart review of EEETO using barbed suture for CSFR at our institution from 2018 to 2021. Scoping review was performed by searching PubMed for articles on EEETO for CSFR. Patients were pooled for data syntheses. RESULTS: Our retrospective series contained 7 patients. Two patients (28.6%) required revision, but all were ultimately successful. Six studies were identified in scoping review for a combined total of 23 patients. Most of the patients initially underwent translabyrinthine (52.2%) resection of vestibular schwannoma (82.6%). Average time to initial CSFR was 362.6 days (standard deviation ± 1034.2, range 0-4320 days). Twenty-two patients underwent lumbar drain, and 11 underwent prior surgical attempts before EEETO. The initial success rate of EEETO was 65.2%. In 8 patients needing revision, EEETO was ultimately successful in 6. There were no differences in demographics or presentation between successful and revision cases. Seven different techniques were described. CONCLUSION: EEETO can treat CSFR after lateral skull base surgery. Revision surgery is common and difficult to predict. Several techniques have been described, and utilization of barbed suture is a viable method with comparable success, but without the need for endoscopic knot tying.

Unidirectional barbed sutures vs. interrupted intracorporeal knots in thoracoscopic repair of congenital diaphragmatic hernia in pediatrics

“…Barbed suture anchoring inhibits migration and can be considered a “continuously interrupted” suture void of knots. It has been established that these sutures have at least the same tissue-holding functioning as traditional sutures ( 6 ). The knotless, self-anchoring design permits simple tissue approximation with less time and cost ( 7 ).…”

Commentary: Endoscopic Endonasal Eustachian Tube Obliteration for Cerebrospinal Fluid Rhinorrhea: Case Series and Scoping Review

“…1 The authors of this manuscript review the role of endoscopic endonasal eustachian tube obliteration (EEETO) for cerebrospinal fluid rhinorrhea (CSFR) and include a retrospective case series. 2 Seven patients from their institution underwent EEETO for CSFR using a novel barbed wire suture technique. The authors address the technical adequacy of EEETO and its challenges, and their series using the V-loc barbed suture device serves to obviate some of these difficulties.…”