31291 Nasal/sinus endoscopy, surgical, with repair of cerebrospinal fluid leak; sphenoid region

Name of the Procedure:

Nasal/Sinus Endoscopy, Surgical, with Repair of Cerebrospinal Fluid Leak; Sphenoid Region

• Common Name(s): Endoscopic CSF Leak Repair
• Technical/Medical Term: Endoscopic Repair of a Sphenoid Region Cerebrospinal Fluid Leak

Summary

This procedure involves using an endoscope to surgically repair a cerebrospinal fluid (CSF) leak occurring in the sphenoid region of the sinuses. An endoscope is a thin, flexible tube with a camera that allows surgeons to view and navigate the nasal passages and sinuses.

Purpose

• Medical Condition/Problem: The procedure addresses cerebrospinal fluid leaks in the sphenoid sinus, which can lead to serious complications like meningitis.
• Goals/Expected Outcomes: To effectively close the CSF leak, prevent infection, and restore normal sinus function.

Indications

• Symptoms/Conditions: Persistent nasal drainage of clear fluid, recurrent meningitis, headaches, and vision disturbances.
• Patient Criteria: Diagnosed with a CSF leak originating from the sphenoid sinus confirmed by imaging studies.

Preparation

• Pre-procedure Instructions: Patients may need to fast for a certain period before the surgery and adjust any medications as directed by their healthcare provider.
• Diagnostic Tests: CT scans or MRI to identify the exact location and extent of the CSF leak.

Procedure Description

1. Anesthesia: The patient is given general anesthesia.
2. Access: An endoscope is inserted through the nostril to visualize the sphenoid sinus.
3. Identification: The surgeon locates the site of the CSF leak.
4. Repair: The leak is repaired using graft materials or tissue adhesives.
5. Completion: The endoscope is removed, and nasal packing may be placed to help with healing.

Duration

The procedure typically takes about 1 to 2 hours.

Setting

• Location: Performed in a hospital or surgical center operating room.

Personnel

• Healthcare Professionals: ENT (Ear, Nose, and Throat) surgeon, anesthesiologist, surgical nurses, and possibly other surgical staff.

Risks and Complications

• Common Risks: Bleeding, infection, nasal congestion.
• Rare Complications: Persistent CSF leak, injury to surrounding structures like blood vessels or optic nerves, anosmia (loss of smell).

Benefits

• Expected Benefits: Repair of the CSF leak, reduced risk of infections like meningitis, relief of associated symptoms.
• Timeline: Benefits are typically realized soon after the surgery once the initial healing process begins.

Recovery

• Post-procedure Care: Patients may need to stay in the hospital for observation. Post-surgery instructions might include nasal irrigation, avoiding strenuous activities, and taking prescribed medications.
• Recovery Time: Most people can return to normal activities within a few weeks, with follow-up appointments to monitor healing.

Alternatives

• Other Treatment Options: Conservative management with bed rest and hydration, lumbar puncture with drainage, or open surgical repair.
• Pros and Cons: Conservative treatments may not always be effective. Open surgical repair is more invasive with a longer recovery time compared to endoscopic repair.

Patient Experience

• During Procedure: The patient will be under general anesthesia and won’t feel anything during the surgery.
• After Procedure: Some discomfort like nasal congestion or mild pain that can be managed with prescribed pain relief. Nasal packing may cause temporary breathing difficulty through the nose.