OUTCOME OF TRANSCRANIAL REPAIR OF TRAUMATIC CSF RHINORRHEA

Authors

  • Ahsan Aurangzeb
  • Ehtisham Ahmed
  • Shahbaz Ali Khan
  • Asghar Ali
  • Adil Ihsan
  • Shakir Mehmood

Abstract

Background: Traumatic brain injury represents a significant cause of mortality and permanent
disability in the adult population. Posttraumatic CSF rhinorrhea is one of the conditions most strongly
associated with severe brain injury. Knowledge on the natural history of the illness and the outcomes
of patients with transcranial subfrontal approach for posttraumatic CSF rhinorrhea approach may help
the neurosurgeon in the decision-making process. This study was conducted to analyse the outcome of
trans-cranial sub-frontal approach for traumatic CSF rhinorrhea, with duroplasty and fibrin glue.
Methods: This study was carried out in the Department of Neurosurgery, Ayub Medical College,
Abbottabad from Jan 2007 to Jun 2011. All patients undergoing trans-cranial sub-frontal repair of
traumatic CSF fistulas were included. Where possible primary dural repair was performed under
hypotensive general anaesthesia and in the cases where it was not possible, graft was used. This was
followed by application of fibrin glue at the repaired site. Graft materials used in this study were taken
from fascia lata, pericranium, and temporalis fascia. Results: Out of 27 patients 21 were men and 6
were women. Age of the patients ranged from 17 to 56 (34.5±4.6) years. Main causes of trauma were
road traffic accidents (23, 85%), fall from height (3, 11%), and assaults (1, 4%). In 23 (85%) cases no
CSF leak was observed in immediate postoperative period as well as during the follow-up visits while
in 3 (11%) cases additional lumber punctures were required to augment the repair. One patient failed
to respond to surgery and lumbar drainage. Conclusion: The CSF rhinorrhea is commonly seen in
patients with anterior skull fractures secondary to head injury. Initially conservative trail should be
given to the patients, if it fails then on-lay dural technique followed by fibrin glue application through
transcranial approach has good outcome with less chances of complications.
Keywords: CSF Rhinorrhea, posttraumatic, repair

References

Hegazy HM, Carrau RL, Snyderman CH, Kassam A, Zweig J.

Transnasal endoscopic repair of cerebrospinal fluid rhinorrhea: a

meta-analysis. Laryngoscope 2000;110:1166-72.

Zweig JL, Carrau RL, Celin SE, Schaitkin BM, Pollice PA,

Snyderman CH, et al. Endoscopic repair of cerebrospinal fluid

leaks to the sinonasal tract: predictors of success. Otolaryngol

Head Neck Surg 2000;123:195-201.

Landeiro JA, Flores MS, Lázaro BC, Melo MH. Surgical

management of cerebrospinal fluid rhinorrhea under endoscopic

control. Arq Neuropsiquiatr 2004;62(3B):827-31.

Abuabara A. Cerebrospinal fluid rhinorrhoea: diagnosis and

management. Med Oral Patol Oral Cir Bucal 2007;12: E397-400.

Wakhloo AK, Van Velthoven, Shumaker M. Evaluation of MR

imaging, digital subtraction cisternography, and CT

Eisternography in diagnosing CSF fistula. Acta Neurochir (wien)

;111:119-27.

Bernal-Sprekelsen M, Bleda-Vázquez C, Carrau RL. Ascending

meningitis secondary to traumatic cerebrospinal fluid leaks. Am J

Rhinol 2000;14(4):257-9.

Scholsem M, Scholtes F, Collignon F, Robe P, Dubuisson A,

Kaschten B, et al. Surgical management of anterior cranial base

fractures with cerebrospinal fluid fistulae: a single-institution

experience. Neurosurgery 2008;62(2):463-9.

Landeiro JA, Lázaro B, Melo MH. Endonasal endoscopic repair

of cerebrospinal fluid rhinorrhea. Minim Invasive Neurosurg

;47(3):173-7.

Nohra G, Jabbour P, Haddad A, Abouhamad W, Abilahoud G,

Okais N. Subcranial subfrontal approach for the treatment of

extensive cerebrospinal fluid leaks. Neurochirurgie 2002;48(2-3

Pt 1):87-91.

Chan DT, Poon WS, IP CP, Chiu PW, Goh KY. How useful is

glucose detection in diagnosing cerebrospinal fluid leak? The

rational use of C and Beta-2 transferrin assay in detection of

cerebrospinal fluid fistula. Asian J Surg 2004;27:39-42.

Yilmazlar S, Arslan E, Kocaeli H, Dogan S, Aksoy K, Korfali E,

et al. Cerebrospinal fluid leakage complicating skull base

fractures: analysis of 81 cases. Neurosurg Rev 2006;29:64-71.

Ahmadi J, Weiss MH, Segal HD, Schultz DH, Zee CS, Giannotta

SL. Evaluation of cerebrospinal fluid rhinorrhea by metrizamide

computed tomography cisternography. Neurosurgery

;16(1):54-60.

Comoy J. Craniofacial injuries. Neurosurgical problems. J

Neuroradiol 1986;13:248-52.

Samli J, Draf W, Lang J. Surgery of the skull base. An

interdisciplinary approach. Berlin: Springer-Verlag; 1989.p. 12-6.

Ekjamel MS. The role of surgery and B2-transferring in the

management of CSF fistulas (MD Thesis). University of

Liverpool 1993.p. 207-19.

Ommaya AK. Cerebrospinal fluid fistula. In: Wilkins RH,

Rengachary SS, (Eds). Neurosurgery. New York: McGraw Hill;

p. 1637-47.

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Published

2012-06-01

How to Cite

Aurangzeb, A., Ahmed, E., Khan, S. A., Ali, A., Ihsan, A., & Mehmood, S. (2012). OUTCOME OF TRANSCRANIAL REPAIR OF TRAUMATIC CSF RHINORRHEA. Journal of Ayub Medical College Abbottabad, 24(2), 47–49. Retrieved from https://jamc.ayubmed.edu.pk/index.php/jamc/article/view/2189

Issue

Vol. 24 No. 2 (2012): JOURNAL OF AYUB MEDICAL COLLEGE, ABBOTTABAD

Section

ORIGINAL ARTICLE

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