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DOI: 10.1055/s-0038-1625975
Fluoroscopy-Assisted Transnasal Onyx Occlusion of the Eustachian Tube for Lateral Skull Base Cerebrospinal Fluid Leak Repair
Funding Internal departmental funding was utilized without commercial sponsorship.Publication History
16 September 2017
01 December 2017
Publication Date:
14 February 2018 (online)
Abstract
Objectives To describe transnasal Eustachian tube (ET) occlusion with a liquid embolic solution for lateral skull base cerebrospinal fluid (CSF) leaks.
Design A lateral skull base CSF fistula model was developed by the authors using fresh cadaveric heads. Using a transtympanic needle, regulated pressurized pigmented saline was continuously instilled into the middle ear space and visualized endoscopically in the nasopharynx. An angioembolization catheter was then placed through the cartilaginous ET orifice just medial to the bony ET. Under endoscopic and fluoroscopic guidance, a column of liquid embolic agent was deployed into the bony ET segment up to the middle ear space.
Setting Tertiary care academic center.
Participants Cadaveric specimens.
Main Outcome Measures Cessation of CSF flow after occlusion at supraphysiologic pressures.
Results In two cadavers, a CSF fistula model was developed and endoscopic visualization of irrigant flow into the nasopharynx was confirmed. Fluoroscopy provided adequate anatomic views of the ET and middle ear, in addition to dynamic views of embolization. Cessation of flow after occlusion was successfully achieved with pressures up to 25 mm Hg, which exceeds normal physiological intracranial pressure.
Conclusion Eustachian tube occlusion with a liquid embolic solution is feasible in a novel cadaveric CSF leak model. In the future, this relatively short, straightforward procedure may become an outpatient alternative to manage intermittent or low-flow CSF fistulae following lateral skull base surgery.
Keywords
cerebrospinal fluid leak - vestibular schwannoma - onyx - fluoroscopy - lateral skull base surgeryInstitutional Review Board Approval
Not applicable (cadaver study).
Off-Label Use
Onyx 18 LES (Medtronic; Minneapolis, MN, United States) is not FDA approved for the indications discussed in this study.
Note
This manuscript was presented in part as a poster at the Combined Otolaryngology Spring Meeting (COSM), American Neurotology Society (ANS), San Diego, CA, 2017. This material has not been previously published in part or whole, and is not currently under consideration for publication elsewhere.
