{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,6]],"date-time":"2026-02-06T05:10:19Z","timestamp":1770354619160,"version":"3.49.0"},"reference-count":16,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"6","license":[{"start":{"date-parts":[[2022,2,7]],"date-time":"2022-02-07T00:00:00Z","timestamp":1644192000000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2022,2,7]]},"abstract":"<jats:sec>\n                    <jats:title>BACKGROUND<\/jats:title>\n                    <jats:p>Rhinorrhea due to lateral skull base cerebrospinal fluid (CSF) leaks can be a challenge to manage. Multiple strategies exist for treating CSF leaks in this region including direct repair, posterior Eustachian tube packing, and CSF diversion. Endonasal closure of the Eustachian tube has been reported using cerclage and mucosal flaps.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>OBSERVATIONS<\/jats:title>\n                    <jats:p>We present the first reported case of endoscopic autologous fat packing of the Eustachian tube orifice to repair a CSF leak. In this case a 42-year-old woman who underwent middle fossa meningioma resection 20 years ago presented with refractory CSF rhinorrhea despite blind sac closure of the ear canal. This persisted after CSF diversion and only resolved after endoscopic endonasal Eustachian tube closure described herein.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>LESSONS<\/jats:title>\n                    <jats:p>This technique is simple to perform with minimal risk of morbidity. Eustachian tube orifice fat packing may be particularly useful for patients with refractory CSF rhinorrhea with low CSF pressure.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3171\/case21590","type":"journal-article","created":{"date-parts":[[2022,2,7]],"date-time":"2022-02-07T02:07:05Z","timestamp":1644199625000},"source":"Crossref","is-referenced-by-count":0,"title":["Endoscopic closure of the Eustachian tube orifice for refractory lateral skull base cerebrospinal fluid leak using autologous fat graft: illustrative case"],"prefix":"10.3171","volume":"3","author":[{"given":"Gautam U.","family":"Mehta","sequence":"first","affiliation":[{"name":"Departments of Neurosurgery and"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Nida","family":"Fatima","sequence":"additional","affiliation":[{"name":"Departments of Neurosurgery and"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Gregory P.","family":"Lekovic","sequence":"additional","affiliation":[{"name":"Departments of Neurosurgery and"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"William H.","family":"Slattery","sequence":"additional","affiliation":[{"name":"Neurotology, House Institute, Los Angeles, California"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1754","reference":[{"issue":"10","key":"b1","series-title":"J Laryngol Otol","doi-asserted-by":"publisher","first-page":"1028","DOI":"10.1017\/S0022215115002157","article-title":"Double seal technique to obliterate the eustachian tube orifice: a novel method for the treatment of recalcitrant cerebrospinal fluid leak","volume":"129","author":"Taghi AS","year":"2015","unstructured":"Taghi AS, Bentley M, Kuchai R, Saleh HA. Double seal technique to obliterate the eustachian tube orifice: a novel method for the treatment of recalcitrant cerebrospinal fluid leak. J Laryngol Otol. 2015; 129(10):1028\u20131031.10.1017\/S00222151150021578817027"},{"issue":"3","key":"b2","series-title":"Am J Otol","first-page":"470","article-title":"Endoscopic closure of the eustachian tube for repair of cerebrospinal fluid leak","volume":"17","author":"Kwartler JA","year":"1996","unstructured":"Kwartler JA, Schulder M, Baredes S, Chandrasekhar SS. Endoscopic closure of the eustachian tube for repair of cerebrospinal fluid leak. Am J Otol. 1996;17(3):470\u2013472.8817027"},{"issue":"6","key":"b3","series-title":"Am J Rhinol","doi-asserted-by":"publisher","first-page":"363","DOI":"10.1177\/194589240401800604","article-title":"Endoscopic closure of the eustachian tube","volume":"18","author":"Orlandi RR","year":"2004","unstructured":"Orlandi RR, Shelton C. Endoscopic closure of the eustachian tube. Am J Rhinol. 2004;18(6):363\u2013365.10.1177\/194589240401800604"},{"issue":"3","key":"b4","series-title":"Neurosurg Focus","doi-asserted-by":"publisher","first-page":"E8","DOI":"10.3171\/2017.12.FOCUS17664","article-title":"Minimally invasive endoscopic repair of refractory lateral skull base cerebrospinal fluid rhinorrhea: case report and review of the literature","volume":"44","author":"Lucke-Wold B","year":"2018","unstructured":"Lucke-Wold B, Brown EC, Cetas JS,  Minimally invasive endoscopic repair of refractory lateral skull base cerebrospinal fluid rhinorrhea: case report and review of the literature. Neurosurg Focus. 2018;44(3):E8.10.3171\/2017.12.FOCUS17664"},{"issue":"1","key":"b5","series-title":"Otolaryngol Head Neck Surg","doi-asserted-by":"publisher","first-page":"88","DOI":"10.1067\/mhn.2003.34","article-title":"Autologous fat grafting for the refractory patulous eustachian tube","volume":"128","author":"Doherty JK","year":"2003","unstructured":"Doherty JK, Slattery WH 3rd. Autologous fat grafting for the refractory patulous eustachian tube. Otolaryngol Head Neck Surg. 2003; 128(1):88\u201391.10.1067\/mhn.2003.34"},{"issue":"3","key":"b6","series-title":"Am J Rhinol Allergy","doi-asserted-by":"publisher","first-page":"207","DOI":"10.2500\/ajra.2015.29.4146","article-title":"Managing cerebrospinal fluid rhinorrhea after lateral skull base surgery via endoscopic endonasal eustachian tube closure","volume":"29","author":"Lemonnier LA","year":"2015","unstructured":"Lemonnier LA, Tessema B, Kuperan AB,  Managing cerebrospinal fluid rhinorrhea after lateral skull base surgery via endoscopic endonasal eustachian tube closure. Am J Rhinol Allergy. 2015; 29(3):207\u2013210.10.2500\/ajra.2015.29.4146"},{"issue":"5-6","key":"b7","series-title":"World Neurosurg","doi-asserted-by":"publisher","first-page":"692","DOI":"10.1016\/j.wneu.2011.01.023","article-title":"Sequelae of autologous fat graft used for reconstruction in skull base surgery","volume":"75","author":"Taha AN","year":"2011","unstructured":"Taha AN, Almefty R, Pravdenkova S, Al-Mefty O. Sequelae of autologous fat graft used for reconstruction in skull base surgery. World Neurosurg. 2011;75(5-6):692\u2013695.10.1016\/j.wneu.2011.01.023"},{"issue":"3","key":"b8","series-title":"Plast Reconstr Surg","doi-asserted-by":"publisher","first-page":"493","DOI":"10.1097\/PRS.0000000000008194","article-title":"Acellular dermal matrix-associated complications in implant-based breast reconstruction: a multicenter, prospective, randomized controlled clinical trial comparing two human tissues","volume":"148","author":"Broyles JM","year":"2021","unstructured":"Broyles JM, Liao EC, Kim J,  Acellular dermal matrix-associated complications in implant-based breast reconstruction: a multicenter, prospective, randomized controlled clinical trial comparing two human tissues. Plast Reconstr Surg. 2021;148(3):493\u2013500.10.1097\/PRS.0000000000008194"},{"issue":"10","key":"b1","series-title":"J Laryngol Otol","doi-asserted-by":"publisher","first-page":"1028","DOI":"10.1017\/S0022215115002157","article-title":"Double seal technique to obliterate the eustachian tube orifice: a novel method for the treatment of recalcitrant cerebrospinal fluid leak","volume":"129","author":"Taghi AS","year":"2015","unstructured":"Taghi AS, Bentley M, Kuchai R, Saleh HA. Double seal technique to obliterate the eustachian tube orifice: a novel method for the treatment of recalcitrant cerebrospinal fluid leak. J Laryngol Otol. 2015; 129(10):1028\u20131031.10.1017\/S0022215115002157"},{"issue":"3","key":"b2","series-title":"Am J Otol","first-page":"470","article-title":"Endoscopic closure of the eustachian tube for repair of cerebrospinal fluid leak","volume":"17","author":"Kwartler JA","year":"1996","unstructured":"Kwartler JA, Schulder M, Baredes S, Chandrasekhar SS. Endoscopic closure of the eustachian tube for repair of cerebrospinal fluid leak. Am J Otol. 1996;17(3):470\u2013472."},{"issue":"6","key":"b3","series-title":"Am J Rhinol","doi-asserted-by":"publisher","first-page":"363","DOI":"10.1177\/194589240401800604","article-title":"Endoscopic closure of the eustachian tube","volume":"18","author":"Orlandi RR","year":"2004","unstructured":"Orlandi RR, Shelton C. Endoscopic closure of the eustachian tube. Am J Rhinol. 2004;18(6):363\u2013365.10.1177\/194589240401800604"},{"issue":"3","key":"b4","series-title":"Neurosurg Focus","doi-asserted-by":"publisher","first-page":"E8","DOI":"10.3171\/2017.12.FOCUS17664","article-title":"Minimally invasive endoscopic repair of refractory lateral skull base cerebrospinal fluid rhinorrhea: case report and review of the literature","volume":"44","author":"Lucke-Wold B","year":"2018","unstructured":"Lucke-Wold B, Brown EC, Cetas JS,  Minimally invasive endoscopic repair of refractory lateral skull base cerebrospinal fluid rhinorrhea: case report and review of the literature. Neurosurg Focus. 2018;44(3):E8.10.3171\/2017.12.FOCUS17664"},{"issue":"1","key":"b5","series-title":"Otolaryngol Head Neck Surg","doi-asserted-by":"publisher","first-page":"88","DOI":"10.1067\/mhn.2003.34","article-title":"Autologous fat grafting for the refractory patulous eustachian tube","volume":"128","author":"Doherty JK","year":"2003","unstructured":"Doherty JK, Slattery WH 3rd. Autologous fat grafting for the refractory patulous eustachian tube. Otolaryngol Head Neck Surg. 2003; 128(1):88\u201391.10.1067\/mhn.2003.34"},{"issue":"3","key":"b6","series-title":"Am J Rhinol Allergy","doi-asserted-by":"publisher","first-page":"207","DOI":"10.2500\/ajra.2015.29.4146","article-title":"Managing cerebrospinal fluid rhinorrhea after lateral skull base surgery via endoscopic endonasal eustachian tube closure","volume":"29","author":"Lemonnier LA","year":"2015","unstructured":"Lemonnier LA, Tessema B, Kuperan AB,  Managing cerebrospinal fluid rhinorrhea after lateral skull base surgery via endoscopic endonasal eustachian tube closure. Am J Rhinol Allergy. 2015; 29(3):207\u2013210.10.2500\/ajra.2015.29.4146"},{"issue":"5-6","key":"b7","series-title":"World Neurosurg","doi-asserted-by":"publisher","first-page":"692","DOI":"10.1016\/j.wneu.2011.01.023","article-title":"Sequelae of autologous fat graft used for reconstruction in skull base surgery","volume":"75","author":"Taha AN","year":"2011","unstructured":"Taha AN, Almefty R, Pravdenkova S, Al-Mefty O. Sequelae of autologous fat graft used for reconstruction in skull base surgery. World Neurosurg. 2011;75(5-6):692\u2013695.10.1016\/j.wneu.2011.01.023"},{"issue":"3","key":"b8","series-title":"Plast Reconstr Surg","doi-asserted-by":"publisher","first-page":"493","DOI":"10.1097\/PRS.0000000000008194","article-title":"Acellular dermal matrix-associated complications in implant-based breast reconstruction: a multicenter, prospective, randomized controlled clinical trial comparing two human tissues","volume":"148","author":"Broyles JM","year":"2021","unstructured":"Broyles JM, Liao EC, Kim J,  Acellular dermal matrix-associated complications in implant-based breast reconstruction: a multicenter, prospective, randomized controlled clinical trial comparing two human tissues. Plast Reconstr Surg. 2021;148(3):493\u2013500.10.1097\/PRS.0000000000008194"}],"container-title":["Journal of Neurosurgery: Case Lessons"],"original-title":[],"link":[{"URL":"https:\/\/thejns.org\/view\/journals\/j-neurosurg-case-lessons\/3\/6\/article-CASE21590.xml","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/thejns.org\/downloadpdf\/journals\/j-neurosurg-case-lessons\/3\/6\/article-CASE21590.xml","content-type":"text\/html","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/thejns.org\/downloadpdf\/journals\/j-neurosurg-case-lessons\/3\/6\/article-CASE21590.xml","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,2,5]],"date-time":"2026-02-05T14:43:50Z","timestamp":1770302630000},"score":1,"resource":{"primary":{"URL":"https:\/\/thejns.org\/view\/journals\/j-neurosurg-case-lessons\/3\/6\/article-CASE21590.xml"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,2,7]]},"references-count":16,"journal-issue":{"issue":"6"},"URL":"https:\/\/doi.org\/10.3171\/case21590","relation":{},"ISSN":["2694-1902"],"issn-type":[{"value":"2694-1902","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,2,7]]}}}