Endoscopic Endonasal Management of Cerebrospinal Fluid Rhinorrhea

Öztürk, Özmen; Polat, Şenol; Üneri, Cüneyd

doi:10.1097/scs.0b013e31824e6a44

Cited by 15 publications

(30 citation statements)

References 11 publications

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“…5 The most common sites of the leaks are the cribriform plate, ethmoid roof, and sphenoid sinus. 6,7 The incidence of iatrogenic CSF rhinorrhea has increased under the rapid development of skull base surgery. Endoscopic transsphenoidal surgery has been reported to have a 1.5% to 4.2% complication rate of CSF rhinorrhea depending on the surgeon's experience.…”

Section: Discussionmentioning

confidence: 99%

Neuroendoscopic Endonasal Management of Cerebrospinal Fluid Rhinorrhea

Zheng¹,

Zhang²,

Tao³

et al. 2015

Journal of Craniofacial Surgery

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Neuroendoscopic endonasal approach has gained popularity in managing traumatic, spontaneous, and especially iatrogenic cerebrospinal fluid (CSF) rhinorrhea. The authors examined 8 patients presenting with CSF rhinorrhea between December 2012 and June 2014: 5 patients had iatrogenic leak, 2 patients had traumatic leak, and 1 patient had a spontaneous onset of CSF rhinorrhea. Sites of the CSF leaks were detected through computed tomographic cisternography and magnetic resonance imaging in the patients with traumatic and spontaneous leaks. All patients received neuroendoscopic endonasal surgery for the CSF leak. The largest defect was 22 mm in maximum diameter. Endoscopic supraciliary "keyhole" approach was performed in 1 patient after confirmation of a frontal sinus leak using the endoscopic endonasal approach. The success rate was 100% in the first attempt. Follow-up period ranged from 3 to 24 months, and no recurrence was reported. Identifying the leak site and choosing the appropriate surgical technique remain the most important factor in surgical success.

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Section: Discussionmentioning

confidence: 99%

Neuroendoscopic Endonasal Management of Cerebrospinal Fluid Rhinorrhea

Zheng¹,

Zhang²,

Tao³

et al. 2015

Journal of Craniofacial Surgery

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show abstract

“…Conservative medical treatment of CSF leaks includes absolute bed rest, antibiotics, putting a lumbar CSF drainage and administration of CSF production reducing drugs such as acetazolamide. 10 This treatment can lead to the development of spontaneous fibrosis, which in turn can help to achieve recovery in some cases. 10 However, the fibrosis-induced improvement before complete closure of the fistula defect still have risk of infection through the fistula region.…”

Section: Discussionmentioning

confidence: 99%

“…10 This treatment can lead to the development of spontaneous fibrosis, which in turn can help to achieve recovery in some cases. 10 However, the fibrosis-induced improvement before complete closure of the fistula defect still have risk of infection through the fistula region. 5,11 Conservative medical treatment also causes high hospital cost and more length of stay in the hospital.…”

Section: Discussionmentioning

confidence: 99%

“…The different surgical techniques can be applied in this procedure. [9][10][11][12] One of the most efficient techniques was placing the graft in an underlying position in the area where the dura was lifted for approximately 0.5 mm near the fistula in the section of the bone defect. This was called underlay or inlay technique in that graft was facing the dura to ensure good adhesion.…”

Section: Discussionmentioning

confidence: 99%

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The efficacy of an endoscopic endonasal approach in the repair of cerebrospinal fluid fistula: a clinical analysis

et al. 2019

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Background: Cerebrospinal fluid (CSF) fistula is an abnormal CSF leakage due to bone and/or dural defect of the skull base and usually operated with endonasal endoscopic approach. The aim of this study was to determine the efficacy of an endonasal endoscopic approach in the repair of CSF leakage and to find the reasons of the recurrence of endoscopic procedure.Methods: The medical records of 24 patients that presented with the diagnosis of cerebrospinal fluid fistula and who had undergone endonasal endoscopic repair surgery were reviewed retrospectively. Results: 13 patients (54.2%) were found to have spontaneous CSF fistulas without any history of trauma, while 11 patients (45.8%) had posttraumatic CSF fistulas. The mean body mass index (BMI) of patients was 31. 3 kg/m² (20.1-49.6). Nasal septal cartilage was used as a graft material in 19 patients (79%) while only fascia was used in 5 patients (21%). The evaluation of long-term results revealed recurrence in 4 patients (16.6%). Two of these patients required a second surgical repair.Conclusions: An endoscopic endonasal approach is a safe method with less morbidity and a reliable outcome in the repair of CSF fistulas. The most important causative factors in the recurrence of endoscopic repair of CSF leak might be to have high BMI and not to use multilayered graft material for closure of fistula.

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“…The approaches for surgical closure include intracranial, transnasal and combined. Endonasal endoscopic closure has become the preferred route for repairing cerebrospinal fluid leaks from anterior skull base as it avoids the need for a craniotomy and associated morbidity . A recent systematic review of endoscopic repair of cerebrospinal fluid leaks has shown a primary closure rate of 90% and low complication rates of <0.03% .…”

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confidence: 99%