Transnasal Endoscopic Repair of Cranionasal Fistulae: A Refined Technique With Long‐term Follow‐up

Abstract

Although the management of cranionasal fistulae has historically plagued otolaryngologists, recent reports of endoscopic techniques for repair of these lesions offer promising results. We present our series of 42 patients whose cranionasal fistulae were managed endoscopically between December 1989 and August 1995. Follow-up ranged from 5 to 68 months, thereby including long-term results from our previously reported series of 29 cases. Resolution of cerebrospinal fluid rhinorrhea was achieved in 35 (83.3%) of 42 patients with one endoscopic procedure, and 3 patients had successful closure at a second surgery. All five cephaloceles were successfully treated with one procedure. We have refined our technique to include specific indications for the use of free grafts depending on the location and size of the cranionasal fistula.

Correção endoscópica de fístula liquórica rinogênica: experiência de 44 casos

“…In our series, success rate of first intervention was of approximately 80%, which is similar to results reported by Schick et al (2001), Burns et al (1996), Hao et al (1996) and Ryet et al Failures were probably due to large defects, such as hernia of meningoencephalic sac at the cribriform area or in the sphenoid sinus ( Figure 5), or to extensive front-basal fractures. Non-recognition of dural defect adjacent to primary defect was the cause of failure in the series of Hao et al (1997).…”

“…Thus, endonasal duraplasty has been successfully used to repair several dura mater lesions with low patient's morbidity rate 2,6,7 .…”

Study on Spontaneous Cerebrospinal Fluid (CSF) Rhinorrhoea: A Birmingham Experience

“…This had the advantage of directly visualising the fistula from above and assessing any co-existing intracranial pathology. Its disadvantages are those of craniotomy with retraction on the frontal lobes causing a high incidence of anosmia, possible cerebral oedema and intracranial haemorrhage with resulting morbidity and mortality 12,13 .…”

Retrospective Study of Endoscopic Management of CSF Rhinorrhoea- A Case Series

“…Various other graft materials have been used in other studies to repair the defectnasal cartilage and mucoperichondrium, middle turbinate flap and fibrin glue. (6,17,18) We used fibrin glue in all the cases.…”