To whom it may concern,
I had surgery last Thursday. It was a "Revision Endoscopic Ethmoidectomy" and a "Tubinectomy." During the procedure, the bone separating the Ethmoid sinus cavity and my brain cavity was torn. The doctor has told me to look / feel / taste for a clear, salty liquid. The day following the surgery, I had nothing but this clear liquid draining from my nose. Sure, there was some blood, but not nearly as much. She has informed me that this was most likely CSF, and I needed to keep my head back from level (nose in the air) and hopefully the tear would heal. She also informed me that she had noticed this tear during the surgery and attempted to repair using flesh from my turbinate and some 'Foam.' She has also informed me that due to this complication, Meningitis could possible be an outcome, if the tear became infected.
My questions to you are:
Reply ----------------------
Cerebrospinal fluid (CSF) leakage is a well-recognized potential
complication of sinus surgery that can occur even in the hands of
experienced sinus surgeons.
Experienced sinus surgeons minimize the risk by careful pre-operative
assessment (appropriate CT scan images) and keeping bleeding to a
minimum during the operation. If a CSF leak should occur, early
recognition and treatment are important. Most often CSF leaks should
be recognized during the surgery with steps to correct the leak taken
immediately. There are a variety of surgical means that can be used in
this setting, including that which you describe your surgeon using.
When CSF leaks occur post-operatively there are both non-operative as well as operative treatments available. Non-operative treatments should be tried first, however. Non-operative treatments include bedrest in a position where the leak does not occur, avoidance of nose blowing, avoidance of straining, and occasionally the placement of a spinal drainage catheter to assist in lowering the spinal fluid pressure to allow the leak to seal on its own. If the leak does not seal in a week, operative therapy is recommended. As I noted, there are a number of operative treatments to repair CSF leaks ranging from simple to complicated, some of which require a neurosurgeon's assistance. Fortunately, the majority of leaks tend to heal with non-operative treatment.
CSF leaks are very serious and can lead to more severe problems such as meningitis or brain abscesses. They must therefore be treated promptly and appropriately. With resolution of the leak, there should be no further risk of problems and therefore no need to curtail athletic activities after an appropriate period of time for proper healing to occur. If there is some question as to whether or not the fluid is actually spinal fluid, there are a number of tests available, including specialized imaging studies, that can help identify the presence of spinal fluid leakage.
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Steve Dankle, MD
Otolaryngology-Head and Neck Surgery
Milwaukee, Wis
NOTICE: OFCN is not engaged in the rendering of professional medical services. The information contained on this system or any other OFCN system should not supplant individual professional consultation. It is offered exclusively as a community education service. Advice on individual problems must be obtained directly from a professional.
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