Management of dural lesions occurring during endonasal sinus surgery.

BACKGROUND

Dural lesions incurred during endonasal sinus surgery must be repaired surgically because of the risk of potentially fatal late meningitis.

DESIGN

Retrospective survey.

SETTING

Ear, nose, and throat department of a university teaching hospital.

PATIENTS

Consecutive sample of 47 patients who had undergone duraplasty for repair of a dural lesion that occurred as a complication of endonasal sinus surgery. Forty-two patients were interviewed after an average postoperative period of more than 5 years.

INTERVENTION

Endonasal duraplasty, external duraplasty (fronto-orbital or transfrontal extradural approach) by underlay or onlay technique.

MAIN OUTCOME MEASURES

Fluorescein test (intrathecal administration of fluorescein sodium and subsequent nasal endoscopy), subjective complaints, history of meningitis, cerebrospinal fluid rhinorrhea, or hyposmia.

RESULTS

There were 44 endonasal and 3 external duraplasties (2 by the fronto-orbital and 1 by the transfrontal extradural approach); the underlay technique was used in 25 and the onlay technique in 22. The fluorescein test, performed in 43% (20/47) of the patients was negative in all cases. Twenty-six percent of the patients had had 1 or more episodes of bacterial sinusitis without meningitis. Duraplasty was clinically intact in 100%. Postoperative olfactory disturbances were reported in 17%.

CONCLUSIONS

Duraplasty can be performed satisfactorily by the endonasal route, thus avoiding the disadvantages of the fronto-orbital approach (visible scar, risk of damage to the supraorbital nerve, and removal of bone from the floor of the frontal sinus with a tendency to stenosis of the nasofrontal duct and subsequent mucocele). Allogeneic connective tissue in combination with fibrin glue has proved suitable as a graft material.