An International Journal Clinical Rhinology

Register      Login

VOLUME 11 , ISSUE 1 ( January-April, 2018 ) > List of Articles

Original Article

Study of Etiology, Outcome and Limitations of Endoscopic Management of Cerebrospinal Fluid Rhinorrhea

Rohit Verma, Alok Thakar

Keywords : Cerebrospinal fluid, Endoscopic, Rhinorrhea, Transnasal

Citation Information : Verma R, Thakar A. Study of Etiology, Outcome and Limitations of Endoscopic Management of Cerebrospinal Fluid Rhinorrhea. Clin Rhinol An Int J 2018; 11 (1):7-14.

DOI: 10.5005/jp-journals-10013-1334

License: CC BY-NC 4.0

Published Online: 01-04-2018

Copyright Statement:  Copyright © 2018; The Author(s).


Abstract

Aim: The advances in endoscopic sinus surgery have made it the procedure of choice for treatment of cerebrospinal fluid (CSF) rhinorrhea. The objective of this study was to study the etiological factors, the outcome of transnasal endoscopic repair, and limitations of the technique. Materials and methods: Thirty-two cases of CSF rhinorrhea were evaluated. Patients underwent thorough clinicoradiological evaluation followed by transnasal endoscopic repair. Patients were followed up at monthly intervals. Results: Out of 32 cases, 14 were due to the head injury, 12 were spontaneous, two were iatrogenic, two congenital defects, one was a case of tubercular osteomyelitis and one was idiopathic. CSF leak was successfully plugged in 29 patients. In one patient, the procedure had to be converted to an extracranial external approach. Two patients underwent successful revision endoscopic procedure. One patient was lost to follow-up. Conclusion: Head injury remains the leading cause of CSF rhinorrhea. The spontaneous leak patients represent a distinct clinical group with a characteristic patient profile, clinical features, and radiology. The results of endoscopic repair are excellent, especially in nonspontaneous cases. We recommend it as the optimum surgical approach for both primary and revisional surgical management of CSF rhinorrhea.


PDF Share
  1. Beckhardt RN, Setzen M, Carras R. Primary spontaneous CSF rhinorrhea. Otolaryngology Head and Neck Surge 1991; 104:425-432.
  2. Dunn CJ, Alaani A, Johnson AP. Study on spontaneous CSF rhinorrhea: its etiology and management. J Laryngol Otol 2005;119:12-15.
  3. Leading article: Deaths from bacterial meningitis in 1973. Br Med J 1974;2:453.
  4. Gray WC, Salcman M. CSF rhinorrhea associated with empty sella syndrome. Arch Otolaryngol 1980;106:302-305.
  5. Schlosser RJ, Bolger WE. Spontaneous nasal CSF leaks and empty sella syndrome: a clinical association. Am J Rhinol 2003;17:91-96.
  6. Park J, Strelzow VV, and Friedman WH. Current management of CSF rhinorrhea. Laryngoscope 1983;93:1294-1300.
  7. Ommaya AK. Spinal fluid fistulae. Clinical Neurosurgery 1976;23:363-392.
  8. Kirtane MV, Gautham K, Upadhyaya SR. Transnasal endoscopic approach for CSF rhinorrhea. Otolaryngol Head Neck Surg 2005;132:208-212.
  9. Burns JA, Dodson EE, Gross CW. Transnasal endoscopic repair of cranionasal fistulae: a refined technique with long term follow-up. Laryngoscope 1996;106:1080-1083.
  10. Hughes RGM Jones NS, Robertson IJA. The endoscopic treatment of CSF rhinorrhea: the Nottingham experience. J Laryngol Otol 1997;111:125-128.
  11. Mao VH, Keane WM, Atkins JP et al. Endoscopic repair of CSF rhinorrhea. Otolaryngol Head Neck Surg 2000;122:56-60.
  12. Papay FA, Maggiano H, Dominquez S, Hassenbusch SJ, Levin HL, Lavertu P. Rigid endoscopic repair of PNS CSF fistulas. Laryngoscope 1989;99:1195-1201.
  13. Mattox DE, Kennedy DW. Endoscopic management of CSF leaks and encephaloceles. Laryngoscope 1990;100:857-862.
  14. Stankiewicz JA. CSF fistula and endoscopic sinus surgery. Laryngoscope 1991;101:250-256.
  15. Dodson EE, Gross CW, Swerdloff JL, et al. Transnasal endoscopic repair of CSF rhinorrhea and skull base defects. Otolaryngol Head Neck Surg 1994;111:600-605.
  16. Shick B, Ibing R, Brors D, et al. Long term study of endonasal duraplasty and review of the literature. Ann Otol Rhinol Laryngol 2001;110:142-147.
  17. Woodworth BA, Schlosser RJ, Palmer JN. Endoscopic repair of frontal sinus CSF leaks. J Laryngol Otol 2005;119: 709-713.
  18. Hegazy HM, Carrau RL, Snyderman CH, Kassam A. Transnasal endoscopic repair of CSF rhinorrhea: a meta-analysis. Laryngoscope 2000;110:1166-1172.
PDF Share
PDF Share

© Jaypee Brothers Medical Publishers (P) LTD.