A Comparative Analysis of Transcranial and Endoscopic Repair for Traumatic CSF Rhinorrhea

Abstract

Introduction The surgical treatment of anterior cranial base traumatic CSF rhinorrhoea is challenging and is fraught with complications. Whether a person should be offered open craniotomy or endoscopic endonasal repair is a dilemma faced by most surgeons. This study is one of the few to directly compare the two forms of management. Methods Data was collected from two groups of 15 patients each who underwent transcranial CSF leak repair and endoscopic endonasal CSF leak repair respectively in a tertiary care hospital over a as a observational study. Information including demographics, recurrence rates, complications and hospital and ICU stay were recorded and analysed. Outcome was assessed up to 6 months. Results Recurrence was seen in 9/30 patients, 6 in the transcranial arm and 3 in the endoscopic arm. Hospital stay more than 1 week was present in all transcranially operated patients and only 73% of endoscopically operated patients (p=0.439) although the ICU stay was reduced in the endoscopic arm (p=0.066). Complications were most common with transcranial repair (7 of 8 patients who underwent transcranial repair p=0.035) with anosmia being the most common, (33.3%, p=0.042). Conclusion Transcranial open repair is a reasonable choice especially for leaks that occur through the frontal sinus and extend backward into the frontoethmoid region. However, this modality has the drawbacks of greater number of complications, higher recurrence rate, longer ICU and overall hospital stay. The endoscopic endonasal repair enjoys a lower morbidity profile although it may not be an adequate treatment for leaks that are placed far laterally in the frontal sinus.

Sphenoid Meningoencephalocele Correction Through a Transpterygoid Approach

“…With the advance of endoscopic surgery, transcranial approaches were replaced by endoscopic endonasal surgery due to its lower morbidity. The exception may be CSF laterally or from the posterior wall of the frontal sinus [ 13 , 14 ]. The endoscopic transpterygoid approach has the advantage of avoiding craniotomy and brain retraction; however, it may result in neurovascular injury of the pterygopalatine fossa content during the access to the lateral recess of the sphenoid sinus [ 3 , 11 ].…”