TRANSNASAL ENDOSOCPIC REPAIR OF CEREBROSPINAL FLUID RHINORRHOEA

Authors

  • Sajid Nazir Bhatti
  • Shahbaz Ali Khan
  • Rizwan Shah
  • Ahsan Aurangzeb
  • Ehtisham Ahmed
  • Farhat Rizvi
  • Khalid Khan Zadran
  • Nazir Alvi

Abstract

Background: Cerebrospinal fluid (CSF) leaks can arise as a complication of trauma, hydrocephalus,endoscopic sinus surgery or it may occur spontaneously without any identifiable cause. Surgicalrepair is recommended in patients who do not respond to the conservative management. In recentyears transnasal endoscopic approach has become the preferred method for repairing the CSF leaksand better outcomes have been reported as compared to the intracranial approaches that werepreviously used. Objective of this study was to analyse the outcome of transnasal endoscopic repairof CSF rhinorrhoea. Methods: This prospective study was conducted in the Department ofNeurosurgery, Ayub Medical College, Abbottabad, from March 2007 to March 2010. Twenty-onepatients with CSF rhinorrhoea were included in study that were diagnosed on the basis of clinicalevaluation, glucose concentration of nasal discharge, computed tomography (CT) and magneticresonance imaging (MRI). These patients did not respond to conservative management and wereoperated transnasally using rigid endoscope. Patients were followed up for a mean duration of 9months and the outcome was analysed. Results: The patients included in the study ranged in the agegroup of 12–55 years. Among the patients 13 (57%) were female and 8 (38%) were males. The causeof CSF rhinorrhoea was traumatic in 16 (76.19%), Idiopathic or spontaneous in 4 (19.04%) and 1(4.7%) case was related to endoscopic surgery for pituitary macroedenoma. In 10 (47.6.8%) patientsthe site of leak was cribriform plate, 5 (23.8%) had from sphenoid, 4 (19.04%) from frontal sinus andin 2 (9.5%) Ethmoid was affected. Primary surgery was successful in 17 (80.95%) of cases. In 2(9.5%) cases re-exploration had to be performed. In 1 patient re-exploration had to be done for thethird time. Overall success rate was 95%. One patient presented with CSF leak and meningitis 1month after surgery and unfortunately died. Conclusion: Transnasal endoscopic repair of CSFrhinorrhoea is highly successful, safe and less traumatic.Keywords: Transnasal endoscopic repair, CSF Rhinorrhoea, CSF leak, transnasal endoscopicduroplasty

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.

Komatsu M, Komatsu F, Cavallo LM, Solari D, Stagno V,

Inoue T, et al. Purely endoscopic repair of traumatic

cerebrospinal fluid rhinorrhea from the anterior skull base: case

report. Neurol Med Chir (Tokyo) 2011;51:222–5.

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.

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.

Locatelli D, Rampa F, Acchiardi I, Bignami M, De Bernardi F,

Castelnuovo P. Endoscopic endonasal approaches for repair of

cerebrospinal fluid leaks: nine-year experience. Neurosurgery

;58(4 Suppl 2):246–56.

El-Banhawy OA, Halaka AN, Altuwaijri MA, Ayad H, ElSharnoby MM. Long-term outcome of endonasal endoscopic

skull base reconstruction with nasal turbinate graft. Skull Base

;18(5):297–308.

El-Banhawy OA, Halaka AN, El-Hafiz Shehab El-Dien A,

Ayad H. Subcranial transnasal repair of cerebrospinal fluid

rhinorrhea with free autologous grafts by the combined overlay

and underlay techniques. Minim Invasive Neurosurg

;47(4):197–202.

Landeiro JA, Lázaro B, Melo MH. Endonasal endoscopic

repair of cerebrospinal fluid rhinorrhea. Minim Invasive

Neurosurg 2004;47(3):173–7.

Castelnuovo PG, Delú G, Locatelli D, Padoan G, Bernardi FD,

Pistochini A, et al. Endonasal endoscopic duraplasty: our

experience. Skull Base 2006;16(1):19–24.

Meco C, Oberascher G, Arrer E, Moser G, Albegger K. Betatrace protein test: new guidelines for the reliable diagnosis of

cerebrospinal fluid fistula. Otolaryngol Head Neck Surg

;129:508–17.

Tamakawa Y, Hanafee WN. Cerebrospinal fluid rhinorrhea:

the significance of an air-fluid level in the sphenoid sinus.

Radiology 1980;135(1):101–3.

Tosun F, Carrau RL, Snyderman CH, Kassam A, Celin S,

Schaitkin B. Endonasal endoscopic repair of cerebrospinal

fluid leaks of the sphenoid sinus. Arch Otolaryngol Head Neck

Surg 2003;129(5):576–80.

Nachtigal D, Frenkiel S, Yoskovitch A, Mohr G. Endoscopic

repair of cerebrospinal fluid rhinorrhea: is it the treatment of

choice? J Otolaryngol 1999;28(3):129–33.

Dandy WD. Pneumocephalus (intracranial pneumocele or

aerocele). Arch Surg 1926;12:949–82

Wigand ME. Transnasal ethmoidectomy under endoscopical

control. Rhinology 1981;19(1):7–15.

Cappabianca P, Cavallo LM, Esposito F, De Divitiis O,

Messina A, De Divitiis E. Extended endoscopic endonasal

approach to the midline skull base: the evolving role of

transsphenoidal surgery. Adv Tech Stand Neurosurg

;33:151–99.

Sieśkiewicz A, Łysoń T, Rogowski M, Mariak Z. Endoscopic

management of cerebrospinal fluid rhinorhea. Otolaryngol Pol

;63:343–7.

Locatelli D, Rampa F, Acchiardi I, Bignami M, De Bernardi F,

Castelnuovo P. Endoscopic endonasal approaches for repair of

cerebrospinal fluid leaks: nine-year experience. Neurosurgery

;58(4 Suppl 2):ONS-246–56.

Castillo L, Jaklis A, Paquis P, Haddad A, Santini J. Nasal

endoscopic repair of cerebrospinal fluid rhinorrhea. Rhinology

;37(1):33–6.

Husain M, Jha D, Vatsal DK, Husain N, Gupta RK.

Neuroendoscopic Transnasal Repair of Cerebrospinal Fluid

Rhinorrhea. Skull Base 2003;13(2):73–8.

Casiano RR, Jassir D. Endoscopic cerebrospinal fluid

rhinorrhea repair: is a lumbar drain necessary? Otolaryngol

Head Neck Surg 1999;121(6):745–50.

Downloads

Published

2011-06-01

Most read articles by the same author(s)

<< < 1 2 3 4 5 > >>