OUTCOME OF TRANSCRANIAL REPAIR OF TRAUMATIC CSF RHINORRHEA
AbstractBackground: Traumatic brain injury represents a significant cause of mortality and permanentdisability in the adult population. Posttraumatic CSF rhinorrhea is one of the conditions most stronglyassociated with severe brain injury. Knowledge on the natural history of the illness and the outcomesof patients with transcranial subfrontal approach for posttraumatic CSF rhinorrhea approach may helpthe neurosurgeon in the decision-making process. This study was conducted to analyse the outcome oftrans-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 oftraumatic CSF fistulas were included. Where possible primary dural repair was performed underhypotensive general anaesthesia and in the cases where it was not possible, graft was used. This wasfollowed by application of fibrin glue at the repaired site. Graft materials used in this study were takenfrom fascia lata, pericranium, and temporalis fascia. Results: Out of 27 patients 21 were men and 6were women. Age of the patients ranged from 17 to 56 (34.5±4.6) years. Main causes of trauma wereroad traffic accidents (23, 85%), fall from height (3, 11%), and assaults (1, 4%). In 23 (85%) cases noCSF leak was observed in immediate postoperative period as well as during the follow-up visits whilein 3 (11%) cases additional lumber punctures were required to augment the repair. One patient failedto respond to surgery and lumbar drainage. Conclusion: The CSF rhinorrhea is commonly seen inpatients with anterior skull fractures secondary to head injury. Initially conservative trail should begiven to the patients, if it fails then on-lay dural technique followed by fibrin glue application throughtranscranial approach has good outcome with less chances of complications.Keywords: CSF Rhinorrhea, posttraumatic, repair
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