Endoscopic repair of cerebrospinal fluid rhinorrhea

Abstract

Endoscopic repair of cerebrospinal fluid rhinorrhea is a promising alternative to traditional repair techniques. This article reports our experience with 21 cases (10 spontaneous, 8 iatrogenic, and 3 traumatic). Various diagnostic radiographic modalities were used, including computer-aided techniques. Most repairs were accomplished with a free fascial graft positioned in the epidural space. Postoperative lumbar drainage was used in 15 cases. Initial repair was successful in 18 cases (85.7%). In all 3 failures, the surgeon had difficulty with proper graft placement. Additionally, 2 of these cases were confounded by early inadvertent removal of the lumbar drain. All patients in whom the procedure failed underwent a second successful endoscopic repair. There were no major complications. In our experience endoscopic repair of cerebrospinal fluid rhinorrhea is a safe and effective approach that can be improved with computer-aided localization devices. Proper graft placement is critical, and lumbar drainage is an important adjunct in selected cases.

Endonasal Endoscopic Repair of Cerebrospinal Fluid Leaks of the Sphenoid Sinus

“…10,15,16,18 Abdominal fat, muscle, hydroxyapatite cement, or acellular dural grafts can be used for obliteration. 7,8,10,17 In our study, most of the CSF fistulas of the sphenoid sinus were repaired by obliteration of the sinus after thorough removal of the mucoperiosteum (15 [58%] of the 26 repairs). The use of different grafts was based mainly on the surgeon's preference, availability of the material, and ease of use.…”

“…Indications for a postoperative lumbar drain are not clearly defined in the literature. Lanza, 17 Mao, 7 and Wormald 4 and colleagues used a lumbar drain postoperatively after the repair of the CSF leak. On the other hand, others 1,8,10 reported a similar success rate without using a lumbar spinal drain.…”

Diagnosis and treatment of cerebrospinal fluid rhinorrhea following accidental traumatic anterior skull base fractures

“…72,80 Various authors have successfully used different types of autologous and nonautologous grafts, such as a mucoperiosteal flap from the middle turbinate or septum or mucoperichondrial, osseous, cartilaginous, fat, muscular fascia, middle turbinate, or septum pedunculated graft, or any combination of these grafts. 1,3,11,13,15,22,[24][25][26]28,35,47,51,55,56,64,65,67,77,79,90,101,108 Another widely discussed issue in endoscopic transnasal repair is whether the grafts used for repair should be placed above (inlay) or beneath (onlay) the skull base defects. In a meta-analysis, Hegazy et al 53 found that both techniques yielded similar results.…”

Cerebrospinal Fluid Rhinorrhea and Recurrent Pneumococcal Meningitis after Submucous Resection of the Nasal Septum

“…Endoscopic repair is a promising alternative to traditional repair techniques. Each technique has some advantages and disadvantages depending on the site of the fistula [13,15,[20][21][22]. Thus, in each patient, the preferred surgical method should be evaluated individually.…”