Endonasal endoscopic repair of cerebrospinal fluid rhinorrhea in a series of 69 patients

Abstract

We presented our experiences in treatment of Cerebrospinal Fluid (CSF) rhinorrhea with an endoscopic endonasal surgery approach, and showed the severe postoperative complications and failures we experienced, in order to outline some of the characteristic problems that can occur. We performed a retrospective analysis of all of the patients with CSF rhinorrhea. All of the patients were managed with an endonasal endoscopic procedure. Data collected included the site of leakage, the surgical interventions, and the postoperative complications. Sixty-nine patients (33 females and 36 males) were included in this study. All patients underwent an endoscopic repair approach with a multilayer reconstructive technique. The success rates of the first attempt in our study were 89%. Four patients presented with postoperative meningitis and brain abscess and one of these patients died of the brain abscess. Our results indicate that an endoscopic endonasal surgery approach provides a wide, safe, and direct route for treatment of CSF rhinorrhea. The precise location of leakage prior to surgery and proper patient selection, eliminating those with large leakages, are helpful in ensuring a successful endoscopic CSF repair with minimal mortality.

Endoscopic management of CSF rhinorrhea

“…Sphenoid and cribriform plate were the commonest sites for spontaneous CSF leaks, whereas posttraumatic patients had CSF leaks from multiple sites, with cribriform plate and sphenoid being common sites in majority of them. [7][8][9][10][11][12][13][14][15] Hence, it is important to inspect all sites corresponding to skull base fractures for evidence of dural breach or CSF leak in patients presenting with traumatic CSF rhinorrhea.…”

Bilateral, spontaneous cerebrospinal fluid rhinorrhoea: endoscopic, uninasal, trans-septal approach for simultaneous closure

“…The first successful endoscopic closure of a CSF leak was performed by Wigand in 1981. 2,4 In a suspected case of CSF rhinorrhoea, clinical examination should be followed by confirmation of the presence of CSF in the nasal fluid. Traditionally, CSF rhinorrhoea caused by craniomaxillary trauma has been treated conservatively with bed rest, head elevation and strict sinus precautions, 4 as observations show that the majority of closed injuries resolve spontaneously.…”

“…Traditionally, CSF rhinorrhoea caused by craniomaxillary trauma has been treated conservatively with bed rest, head elevation and strict sinus precautions, 4 as observations show that the majority of closed injuries resolve spontaneously. 3 Ye et al 2 performed a retrospective study estimating the glucose concentration of nasal discharge, to confirm the presence of extracranial CSF. 5,8 Therefore, all post-traumatic, ongoing CSF leaks need to be repaired.…”

“…1,2 Few authors 3,4 have reported iatrogenic injury (i.e. 1,2 Few authors 3,4 have reported iatrogenic injury (i.e.…”

Successful Endoscopic Repair of Persistent Cerebrospinal Fluid Leak Following Attempted Transcranial Repair

“…13 The most common locations are the cribriform plate and frontoethmoidal sinuses. 2,9,[14][15][16] Fortunately, an estimated 70% of traumatic CSF leaks resolve spontaneously, but these patients are at an increased risk of 30 to 40% in developing ascending meningitis. 15 The remaining 15 to 23% of CSF leaks are idiopathic, usually in the sphenoid sinus and cribriform plate.…”