Bath-plug technique for the endoscopic management of cerebrospinal fluid leaks in children

Xiaojian Yang; Lixing Tang; Pengpeng Wang; Ming Ge; Wei Zhang; Xiao Xiao; Yang Han; Wentong Ge

doi:10.1002/ped4.12354

Bath-plug technique for the endoscopic management of cerebrospinal fluid leaks in children

Pediatr Investig. 2022 Nov 22;7(1):23-28. doi: 10.1002/ped4.12354. eCollection 2023 Mar.

Authors

Xiaojian Yang¹, Lixing Tang¹, Pengpeng Wang¹, Ming Ge², Wei Zhang¹, Xiao Xiao¹, Yang Han¹, Wentong Ge¹

Affiliations

¹ Department of Otorhinolaryngology, Head and Neck Surgery Beijing Children's Hospital Capital Medical University National Center for Children's Health Beijing China.
² Department of Neurosurgery Beijing Children's Hospital Capital Medical University National Center for Children's Health Beijing China.

Abstract

Importance: The safety and efficacy of the bath-plug technique for the closure of cerebrospinal fluid (CSF) leaks in children remain unknown.

Objective: We undertook this study to ascertain whether the bath-plug technique was safe and effective for the repair of CSF leaks.

Methods: We retrospectively reviewed patients who underwent endoscopic repair of CSF leaks with the fat graft as a plug-in at Beijing Children's Hospital from March 2016 to May 2020. Demographic data, medical history, defect sites and sizes, interventions, and clinical outcomes were analyzed. One representative clinical case was additionally selected to highlight the procedure and the healing process.

Results: A total of 18 pediatric patients were included in this study. The group was composed of 11 boys and seven girls, aged from 5 to 123 months. The etiologies included congenital CSF leaks (n = 9) and head trauma (n = 9). Among all patients, 12 fistulas (66.7%) were located at the cribriform plate area, two (11.1%) at the roof of the ethmoid sinuses, two (11.1%) in the sphenoid sinus, and two (11.1%) at the frontal sinus. The maximum diameters of fistulas ranged from 5 to 20 mm, with a median value of 8 mm. Encephaloceles were identified in 14 (77.8%) patients. No hydrocephalus was recognized. All CSF leaks were successfully repaired with a bath-plug technique. Follow-up ranged from 50 to 70 months. No surgical complications were encountered in any patient.

Interpretation: Bath-plug technique is safe and reliable for the endoscopic management of CSF leaks in children. Meticulous peri-operative preparations are important for pediatric patients.

Keywords: Cerebrospinal fluid leak; Child; Endoscopic surgery; Skull base reconstruction.