Steroid-Eluting Stent Bolster for CSF Leak Reconstruction during Endoscopic Endonasal Repair

Introduction: Endoscopic endonasal cerebrospinal fluid (CSF) leak repair is highly successful utilizing a plethora of reconstructive techniques and materials including biosynthetic materials, free mucosal grafts, and vascularized flaps, etc. Steroid-eluting bioabsorbable stents are frequently used during functional endoscopic sinus surgery (FESS) for chronic rhinosinusitis to reduce edema, inflammation, and scarring while maintaining patency of sinuses/sinus ostia. The aim of this study was to assess the feasibility and efficacy of a steroid-eluting stent as an adjunct to conventional bolstering for endoscopic endonasal CSF leak repair.

Methods: This is a retrospective review of patients undergoing endoscopic endonasal CSF leak repair with a steroid-eluting stent placed as part of the bolster technique at a tertiary care center between January 2019 and August 2020. Age, sex, BMI, comorbid idiopathic intracranial hypertension (IIH), pathology, location of CSF leak, intraoperative CSF leak flow, reconstruction type, and presence of post-op CSF leak were recorded.

Results: Eight patients were identified as having a steroid-eluting stent placed as a part of the bolster technique in endoscopic CSF leak reconstruction. The mean age was 47 years (36–81 years) and 62.5% of patients were female, with a median BMI of 25.5 (21.6–46.6). Overall, 37.5% percent of patients had comorbid IIH. The most common pathology was encephalocele (50%) with the most common location being the cribriform/ethmoid roof (50%). One patient did not have an active leak at the time of reconstruction, while 50% had a low-flow leak and 37.5% of patients had a high-flow leak. Reconstruction was performed with either a middle turbinate-free mucosal graft (2), inferior turbinate-free mucosal graft (1), middle turbinate flap (2), or nasoseptal flap (3). One patient with comorbid IIH had a post-op CSF leak at a secondary site (not bolstered with a stent). No post-op CSF leaks occurred at a reconstruction site with a stent.

Conclusion: Steroid eluting stent placement as an adjunct to graft/flap bolster during endoscopic CSF leak repair appears to be safe and effective. A larger, prospective, controlled study will be necessary to study the efficacy of this method compared with other nonresorbable bolster/buttress techniques.

No conflict of interest has been declared by the author(s).

Publication History

Article published online:
12 February 2021