Complications of Cerebrospinal Fluid Leak During Endonasal Dacryocystorhinostomy: Case Series and Review of Literature.

Cerebrospinal fluid (CSF) leak during endonasal dacryocystorhinostomy is a rare, life-threatening, and underreported complication. We present 3 cases of 2 males and 1 female with an age range of 48 to 79 years. All cases involved patients with narrow nasal passages and were performed by early career surgeons. No intraoperative complications were noted in 2 cases, while severe epistaxis occurred in 1 case during superior osteotomy. All patients developed a headache within the first 48 hours, and cerebrospinal fluid rhinorrhea occurred in 1 case. Two patients developed bacterial meningitis and required intubation and ventilatory support, with 1 fatality. Imaging revealed pneumocephalus in all cases and a transverse venous sinus thrombosis in one. A break in the fovea ethmoidalis was identified in all cases, located posterior to the lacrimal sac. These defects were either at the vertical insertion of the middle turbinate or in association with an extended osteotomy superoposteriorly to the sac.