TRANSNASAL ENDOSOCPIC REPAIR OF CEREBROSPINAL FLUID RHINORRHOEA
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 endoscopicduroplastyReferences
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.
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