INNOVATIVE ENDOSCOPIC SOLUTION FOR CSF LEAK REPAIR USING MIDDLE TURBINATE AND HADAD-BASSAGASTEGUY FLAP

Background: This case series documents a new method of CSF leak repair done at a tertiary ENT centre in South India. In the study period of 2 years, 200 FESS cases were done. In sinus surgery, if the skull base is extensively eroded due to the disease process, this may often lead to a leak of cerebrospinal fluid from the skull base defects during the surgery process, and there are also several cases of idiopathic CSF leaks. Thus, an effective management issue arises with leaks. These CSF leaks may be challenging to repair, and therefore techniques are indispensable to prevent all forms of harm to patients, resulting in long-term good outcomes. Study Design: Prospective case series over two years involving 200 patients undergoing functional endoscopic sinus surgery (FESS). Four cases with CSF leaks (three intraoperative, one idiopathic) were repaired using an endoscopic technique combining resected middle turbinate bone with a Hadad-Bassagasteguy flap and resected middle turbinate. Patients were followed for two years to assess outcomes. Study Setting: Single tertiary care otorhinolaryngology center in southern India, serving as a regional referral hospital with advanced endoscopic surgical capabilities. Participants- 200 patients undergoing functional endoscopic sinus surgery (FESS). Four cases with CSF leaks. Method- In 200 total procedures, CSF leaks were identified in three patients intraoperatively. The HadadBassagasteguy flap with resected bone from the middle turbinate of the patient obliterated each leak. One idiopathic CSF rhinorrhoea with a meningocele was treated by the same technique, sealing the defect by placing resected and reshaped part of the middle turbinate bone and overlapping it entirely with the Hadad flap. No synthetic materials or free grafts were needed. All repairs were done in the least invasive manner using endoscopy. Results: All CSF leaks in this series healed without recurrence (0% recurrence), with a two-year follow-up period. This technique of closing CSF leak is safe and minimally invasive, with successful outcomes and no complications. There were no complications for the patients regarding the partial resection of the middle turbinate; therefore, they had an excellent recovery, without any signs of infection or worries of the graft's displacement. Conclusion: This case series highlights the simplicity and effectiveness of the Hadad-Bassagasteguy flap combined with resected middle turbinate bone in the treatment of CSF leak repair. The resected middle turbinate will provide additional support to the Hadad flap. This is a minimally invasive procedure that can avoid the use of additional grafts for patients, thereby reducing the morbidities associated with additional grafts and minimizing possible complications. More importantly, this method provides more reinforcement to the Hadad-Bassagasteguy flap in cases with high intracranial pressure. This newer method has resulted in sustained strong outcomes even after two years of follow-up.