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 – 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 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). 37.5% percent of patients had comorbid IIH. The most common pathology was encephalocele/meningocele (62.5%) with the most common location being the frontoethmoid (37.5%). 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 non-resorbable bolster/buttress techniques.