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Journal Français d'Ophtalmologie
Vol 30, N° 2  - février 2007
pp. 129-134
Doi : JFO-02-2007-30-2-0181-5512-101019-200609584
Cerebrospinal fluid leakage after endonasal dacryocystorhinostomy
 
Figure 1

Figure 1a

Figure 1b

(a) Preoperative axial CT scan showing a marked deviation of the nasal septum (open arrow), adjacent to the opacified lacrimal sac (dotted arrow). (b) Preoperative coronal CT scan. A major meningeal prolapse can be seen below the equator of the orbit (solid arrow), and the marked deviation of the nasal septum (open arrow). The nasal septum is inserted onto the cribriform plate (*) instead of the crista galli. The right middle turbinate is atrophic and distant from the lacrimal duct.
Figure 2

Coronal CT scan sections. (a) Preoperative section at the level of the ethmoidal breach that was observed postoperatively. (b) Postoperative day 1, revealing the breach in the roof of the ethmoid (solid arrow) and massive intracranial pneumatization (*). (c) Postoperative day 2, 1 day following endonasal repair of the ethmoidal breach (dotted arrow pointing to the autologous cartilage plug). Open arrow indicates the hypodense autologous fat plug. (d) Section at day 41 showing the plugged breach and the complete resolution of pneumoencephalocele (*). Open dotted arrow pointing at the fat plugs.
Figure 3

Schematic rendition of the surgical repair method using a technique similar to that of Wormald and McDonogh, [15], [16] with some modifications (sagittal section). Five spheres of abdominal fat (dotted arrow), each 5 mm in diameter, were threaded onto a 4/0 polysorbate monofilament and slid up onto the cartilage graft (solid arrow) blocked by a knot (solid short arrow). The first two fat grafts were placed intracranially (*) to improve the sealing effect of the cartilage plate. Three more fat grafts were placed beneath the ethmoidal roof. Tissue glue was then used to seal a piece of Surgicel® (S) over this composite fat/cartilage graft. The right inferior turbinate (white arrow), from which the cartilage patch had been harvested, was then glued into place as an outer cover onto the composite graft and held in place using a pressure packing of reinforced silastic tubing and Merocel™.
Figure 4

Endoscopic view of the right nasal fossa at 16 months postoperatively. (a) Low magnification showing the reclined mucosa of the main part of the lacrimal sac (solid arrow), the open section of the middle turbinate (open arrow), and the area of the graft (dotted arrow). (b) High magnification reveals the lacrimal fossa, the middle turbinate (open arrow) and the area of the graft (dotted arrow).


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