Endoscopic Repair of Cerebrospinal Fluid Rhinorrhea: Learning from Our Failures

2001 ◽  
Vol 15 (5) ◽  
pp. 333-342 ◽  
Author(s):  
Paolo Castelnuovo ◽  
Silvia Mauri ◽  
Davide Locatelli ◽  
Enzo Emanuelli ◽  
Giovanni Delù ◽  
...  
Keyword(s):  
Cerebrospinal Fluid ◽  
Success Rate ◽  
Csf Leak ◽  
Graft Material ◽  
Literature Analysis ◽  
Endoscopic Repair ◽  
Common Procedure ◽  
Csf Rhinorrhea ◽  
Cerebrospinal Fluid Rhinorrhea

Endoscopic repair of cerebrospinal fluid (CSF) rhinorrhea is becoming a common procedure. The purpose of this study was to perform a literature analysis centering cases of treatment failure and to review our 31 cases with a 1-year minimum follow-up. An extensive search of the literature was conducted, which focused on success rate, follow-up, diagnostic techniques, graft material used, failure rate, and comments on failures. A retrospective analysis of our 31 patients was carried out, and all cases were treated with the endoscopic approach with a 1-year minimum follow-up. From the literature analysis, the median success rate at the first endoscopic attempt is 90%. Our success rate was 87.1%. Failures were analyzed. A unique protocol for CSF leak diagnosis does not exist; we suggest our diagnostic algorithm. Graft material used depends on the authors’ experience, and based on this review of cases to date, did not significantly influence the success rate. The analysis of cases of failure shows that the majority of authors omit details. More research is needed to improve prevention of failures.

scholarly journals Transnasal Endoscopic Cerebrospinal Fluid Rhinorrhea Repair: Our Experience of 35 Cases

2014 ◽  
Vol 7 (2) ◽  
pp. 47-51 ◽  
Author(s):  
Mohnish Grover ◽  
Pawan Singhal ◽  
Shashank Nath Singh ◽  
Man Prakash Sharma ◽  
Avani Jain
Keyword(s):  
Cerebrospinal Fluid ◽  
Success Rate ◽  
Csf Leak ◽  
Endoscopic Repair ◽  
Csf Rhinorrhea ◽  
Cerebrospinal Fluid Rhinorrhea ◽  
Endoscopic Techniques ◽  
The Past ◽  
Intracranial Complications ◽  
Csf Leaks

ABSTRACT Cerebrospinal fluid rhinorrhea results from a breakdown of barriers between the subarachnoid space and aerodigestive tract. Because of the risk of potential intracranial complications, all persistent cerebrospinal fluid (CSF) leaks should be repaired. Over the past few decades, with the advances in endoscopic techniques, the surgical management of CSF rhinorrhea has changed significantly. CSF leak repair has advanced from the conventional open intracranial approaches by neurosurgeons to the transnasal endoscopic ones by otorhinolaryngologists. In this study, 35 patients with CSF leaks underwent endoscopic repair with a 94.3% first attempt success rate, and 100% overall success rate. There were no major intraoperative or postoperative complications. To conclude, the endoscopic approach has a high success rate with minimal morbidity and has therefore, become the preferred method. How to cite this article Jain A, Singhal P, Sharma MP, Singh SN, Grover M. Transnasal Endoscopic Cerebrospinal Fluid Rhinorrhea Repair: Our Experience of 35 Cases. Clin Rhinol An Int J 2014;7(2):47-51.

Cerebrospinal Fluid Rhinorrhea: The Place for Endoscopic Surgery

2010 ◽  
Vol 3 (1) ◽  
pp. 11-12
Author(s):  
Arvind Soni
Keyword(s):  
Cerebrospinal Fluid ◽  
Endoscopic Surgery ◽  
Revision Surgery ◽  
Safe Procedure ◽  
Endoscopic Repair ◽  
Csf Rhinorrhea ◽  
Cerebrospinal Fluid Rhinorrhea ◽  
Transnasal Endoscopic Repair

Abstract Transnasal endoscopic repair of CSF rhinorrhea is an effective and safe procedure. A retrospective follow-up of nineteen patients who underwent transnasal endoscopic repair was done. A variety of graft materials and grafting techniques were used. None of the patients had any complications or required revision surgery.

Endonasal Endoscopic Management of Frontal Sinus Cerebrospinal Fluid Leak

2017 ◽  
Vol 31 (6) ◽  
pp. 406-411 ◽  
Author(s):  
Javaneh Jahanshahi ◽  
Mehdi Zeinalizadeh ◽  
Hasan Reza Mohammadi ◽  
Seyed Mousa Sadrehosseini
Keyword(s):  
Cerebrospinal Fluid ◽  
Skull Base ◽  
Frontal Sinus ◽  
Surgical Approaches ◽  
Endoscopic Management ◽  
Graft Material ◽  
Endoscopic Repair ◽  
Skull Base Reconstruction ◽  
Csf Rhinorrhea

Background A frontal sinus leak is uncommon and is seen in ∼15% of cases of patients with cerebrospinal fluid (CSF) rhinorrhea. Now, endonasal endoscopic techniques have been reported to reconstruct skull base defects in the frontal sinus with a favorable outcome. Objective To review our experience in the repair of frontal sinus CSF leaks through an endonasal endoscopic approach. Methods Twenty-four patients with a frontal sinus leak who underwent endonasal endoscopic repair entered the study. Clinical presentation, location, frontal sinusotomy, graft material, follow-up, and frontal sinus status were evaluated. Results Among >100 cases of surgically repaired CST rhinorrhea, the frontal sinus was the site of the leak in 24 patients (mean age, 28.9 years; mean follow-up, 22 months). The etiology consisted of spontaneous leak and traumatic leak; whereas patients with skull base reconstruction after removal of tumor were excluded. Surgical approaches included Draf IIb, Draf III, Draf IIa in 20, 3, and 1 patients, respectively. Tree autografts as two-layer inlay fat–muscle and onlay fascia lata were used in the majority of patients. A success rate was achieved in 95.83% of the patients. Conclusion Endonasal endoscopic repair of a frontal sinus leak was a successful procedure, with a low failure rate and minimal morbidity.

scholarly journals Endoscopic endonasal cerebrospinal fluid rhinorrhea repair: a cohort study in Iraq

2021 ◽  
Vol 37 (1) ◽  
Author(s):  
Ammar Abdulkadhim Hasan ◽  
Saad Farhan Al-Saedi ◽  
Mukhallad Mahdi Saleh ◽  
Hani Musa Al-Akbi
Keyword(s):  
Cerebrospinal Fluid ◽  
Success Rate ◽  
Fascia Lata ◽  
Csf Leak ◽  
Surgical Approaches ◽  
Tensor Fascia Lata ◽  
Endoscopic Endonasal ◽  
Csf Rhinorrhea ◽  
Cerebrospinal Fluid Rhinorrhea ◽  
Wide Range

Abstract Background Cerebrospinal fluid (CSF) rhinorrhea is a condition where the protective fluid that surrounds the brain finds its way into the nose and sinuses, often appearing as a very watery runny nose. The main surgical approaches for the surgical repair of CSF leaks are intracranial and extracranial. Over the last decade, endoscopic surgery has established itself as the most widely used technique for the repair of CSF fistula. The current study aimed to describe the use of nasal endoscopic technique in the management of cerebrospinal fluid rhinorrhea repair. Results Results of our study showed that in addition to CSF leak, 40% of the patients had headache and 17.5% had repeated meningitis. Half of the etiologies for the CSF leak were spontaneous, 35% were congenital, and 15% were traumatic. The more frequent site of leak was left cribriform plate (37.5%). In the majority of patients, 37/40 (92.5%), the type of graft was tensor fascia lata and fat, while in the remaining 3 patients, type of graft was tensor fascia lata and bone, bone and fat, and tensor fascia lata. The repair succeeded in 35 patients giving a success rate of 87.5%. Conclusion It can be concluded that wide range of age groups from 2–62 years presented as CSF rhinorrhea with female predominance, and there was high success rate of endoscopic CSF rhinorrhea repair with low morbidity.

Endoscopic Closure of CSF Rhinorrhea: 193 cases in 21 years

2008 ◽  
Vol 139 (2_suppl) ◽  
pp. P76-P76
Author(s):  
Caroline Amber Banks ◽  
David W Kennedy ◽  
James N Palmer ◽  
Alexander G Chiu ◽  
Bert W O'Malley ◽  
...  
Keyword(s):  
Success Rate ◽  
Large Series ◽  
Csf Leak ◽  
Graft Material ◽  
Recurrence Rates ◽  
Csf Rhinorrhea ◽  
Endoscopic Closure ◽  
History Of ◽  
Csf Leaks

Objective Over the past 2 decades, endoscopic repair of cerebrospinal fluid (CSF) leaks has become a routine treatment. The goal of this study is to describe endoscopic closure of a large series of traumatic and spontaneous CSF leaks over a 21-year period, focusing on perioperative management, surgical technique, and long-term outcomes. Methods Retrospective chart review of CSF leak patients treated by the senior author and at the Hospital of the University of Pennsylvania from 1987 to 2008. The data analyzed included BMI, etiology, defect location, graft material, presence of encephalocele, use of lumbar drain, history of meningitis, evidence of intracranial hypertension, recurrence rates, and follow-up. Results 193 cases were identified. Follow-up ranging from 1 month to 9 years (mean 20 months) was available on 166 patients. The etiology was spontaneous in 77 patients (40%), traumatic in 109 (56%), and congenital in 7 patients (4%). The average BMI of spontaneous CSF leak patients (35) was significantly greater (p<0.001) than both traumatic (30) and congenital patients (23). Defects were most commonly located in the sphenoid sinus (n = 62, 32%) and the ethmoid roof (n = 60, 31%). The initial success rate was 88% (n = 170) and the overall success rate was 98% (n = 190). 45 patients (23%) had a history of meningitis, and 4 patients (2%) developed meningitis after repair. Conclusions The overall success rate (98%) and low incidence of morbidity in this large series strongly support the endoscopic approach as standard of care for CSF leak closure.

Endoscopic Repair of Cerebrospinal Fluid (CSF) Rhinorrhea with Multilayer Grafts

2021 ◽  
Vol 6 (1) ◽  
pp. 1291-1297
Author(s):  
Sriti Manandhar ◽  
K R Meghanadh ◽  
N V R Reddy
Keyword(s):  
Cerebrospinal Fluid ◽  
Revision Surgery ◽  
Middle Turbinate ◽  
Csf Leak ◽  
Endoscopic Repair ◽  
Radiological Investigation ◽  
Csf Rhinorrhea ◽  
Female Ratio ◽  
Cerebrospinal Fluid Rhinorrhea ◽  
Post Surgery

Introduction: Endoscopic repair of Cerebrospinal fluid (CSF) rhinorrhea has been the most popular and the most accepted among the Otorhinolaryngologists. The advancement in the endoscopes enable surgeons to manage cerebrospinal fluid rhinorrhea adequately with good result. Objective: The aim of this study was to evaluate the outcome of endoscopic CSF rhinorrhea repair with multilayer grafts. Outcome was identified in terms of postoperative complications like infection (mainly meningitis), nasal bleeding, graft failure and CSF leak, revision surgery. Methodology: A retrospective prospective study was conducted in 21 patients who had undergone endoscopic CSF rhinorrhea repair with use of multilayer grafts in a period of January 2016 to December 2018 in Department of ENT and Head and Neck Surgery in MAA ENT HOSPITAL, HYDERABAD, INDIA. All the patients were diagnosed according to history, clinical examination, diagnostic nasal endoscopy, CSF fluid analysis and radiological investigation. The materials used for the repair of CSF rhinorrhea were surgicel, temporalis fascia, conchal chondroperichrondrium, middle turbinate free mucoperiosteum graft, thigh fat and fascia lata. The follow up period of patients range from 14-44 months. The outcome of endoscopic CSF repair with use of multilayer grafts was evaluated by electronic records regarding recurrence of CSF rhinorrhea post-surgery, hospital admission, revision surgery and digital record of rigid endoscopic findings for the status of graft uptake and CSF leak. Results: In all patients, CSF leak was successfully repaired with use of multilayer grafts in first attempt without any complication. There was female predominance with male to female ratio of 1:6.The mean age of presentation was 43.09years. All 21 patients were presented with spontaneous CSF leak with unknown cause. In 21 patients only one patient presented with bilateral cerebrospinal fluid leak. Cribri form plate was the commonest site of defect in which defect medial to middle turbinate was the commonest followed by ethmoid roof and lateral wall of sphenoid. None of the patients developed meningitis after surgery. None of the patients required lumbar drain. None of the patients presented with cerebrospinal fluid rhinorrhea postoperatively. Conclusions: Endoscopic repair of Cerebrospinal fluid rhinorrhea with the use of multilayer grafts is the safer and effective method with good outcome. 

scholarly journals Transnasal Endoscopic Repair of Cerebrospinal Fluid Rhinorrhea

2017 ◽  
Vol 10 (2) ◽  
pp. 45-48
Author(s):  
Devang P Gupta ◽  
SK Dinesh ◽  
Ashil D Manavadaria
Keyword(s):  
Cerebrospinal Fluid ◽  
Conservative Management ◽  
Sinus Surgery ◽  
Csf Leak ◽  
Endoscopic Repair ◽  
Csf Rhinorrhea ◽  
Cerebrospinal Fluid Rhinorrhea ◽  
Medical College ◽  
Primary Surgery ◽  
Transnasal Endoscopic Repair

ABSTRACT Introduction Cerebrospinal fluid (CSF) leak can arise as a complication of trauma, hydrocephalus, endoscopic sinus surgery, or it may occur spontaneously without any identifiable cause. Surgical repair is recommended in patients who do not respond to the conservative management. In recent years, transnasal endoscopic approach has become the preferred method for repairing CSF leaks, and better outcomes have been reported as compared with the intracranial approaches that were previously used. The objective of this study was to analyze the outcome of transnasal endoscopic repair of CSF rhinorrhea. Materials and methods This prospective study was conducted in the Department of ENT, B.J. Medical College, Ahmedabad, India, from April 2013 to July 2016. Twenty-five patients with CSF rhinorrhea were included in the study. They were diagnosed based on the clinical evaluation, computed tomography, and magnetic resonance imaging. These patients did not respond to conservative management and were operated transnasally using rigid endoscope. Patients were followed up for a mean duration of 9 months, and the outcome was analyzed. Results The patients included in the study ranged in the age group of 12 to 55 years. Among the patients, 15 were females and 10 were males. The cause of CSF rhinorrhea was traumatic in 18, idiopathic or spontaneous in 7. In 12 patients, the site of leak was cribriform plate, 6 from ethmoid, 5 from sphenoid sinus, and in 2 frontal sinuses were affected. Primary surgery was successful in 23 of cases. In two cases, reexploration had to be performed. Overall success rate was 100%. Conclusion Transnasal endoscopic repair of CSF rhinorrhea is highly successful, safe, and less traumatic. How to cite this article Gupta DP, Dinesh SK, Manavadaria AD. Transnasal Endoscopic Repair of Cerebrospinal Fluid Rhinorrhea. Clin Rhinol An Int J 2017;10(2):45-48.

The Use of Methylene Blue Staining Test in Determining the CSF Leaks Location of the Anterior Skull Base

2018 ◽  
Vol 69 (6) ◽  
pp. 1376-1377
Author(s):  
Razvan Hainarosie ◽  
Teodora Ghindea ◽  
Irina Gabriela Ionita ◽  
Mura Hainarosie ◽  
Cristian Dragos Stefanescu ◽  
...  
Keyword(s):  
Methylene Blue ◽  
Cerebrospinal Fluid ◽  
Intrathecal Injection ◽  
Diagnostic Procedures ◽  
Blue Staining ◽  
Csf Leak ◽  
Glucose Content ◽  
Csf Rhinorrhea ◽  
Cerebrospinal Fluid Rhinorrhea ◽  
Csf Leakage

Cerebrospinal fluid rhinorrhea represents drainage of cerebrospinal fluid into the nasal cavity. The first steps in diagnosing CSF rhinorrhea are a thorough history and physical examination of the patient. Other diagnostic procedures are the double ring sign, glucose content of the nasal fluid, Beta-trace protein test or beta 2-transferrin. To establish the exact location of the defect imagistic examinations are necessary. However, the gold standard CSF leakage diagnostic method is an intrathecal injection of fluorescein with the endoscopic identification of the defect. In this paper we analyze a staining test, using Methylene Blue solution, to identify the CSF leak�s location.

scholarly journals Extracranial Repair of Cerebrospinal Fluid Rhinorrhea

1990 ◽  
Vol 17 (3) ◽  
pp. 320-323 ◽  
Author(s):  
Ian B. Ross ◽  
Austin R.T. Colohan ◽  
Martin J. Black
Keyword(s):  
Cerebrospinal Fluid ◽  
Successful Treatment ◽  
Csf Leak ◽  
High Morbidity ◽  
Csf Rhinorrhea ◽  
Cerebrospinal Fluid Rhinorrhea ◽  
Transcranial Approach ◽  
Ethmoid Sinuses

ABSTRACT:There has been a recent renewal of interest in the extracranial repair of cerebrospinal fluid rhinorrhea because of the relatively high morbidity associated with the transcranial approach. The authors describe an extracranial approach that involves packing of the sphenoid and ethmoid sinuses on the side of the CSF leak. A case of successful treatment of CSF rhinorrhea by this method is presented. The extracranial approach may be advantageous for the repair of CSF rhinorrhea and the authors advocate an increase in its utilization by neurosurgeons and otolaryngologists working as a team.

CT Cisternography of Paradoxical Cerebrospinal Fluid Rhinorrhea after Operation for Acoustic Neuroma

2005 ◽  
Vol 18 (5-6) ◽  
pp. 555-558 ◽  
Author(s):  
B. Thomas ◽  
S. Purkayastha ◽  
S. Vattoth ◽  
A.K. Gupta
Keyword(s):  
Cerebrospinal Fluid ◽  
Acoustic Neuroma ◽  
Cerebellopontine Angle ◽  
Csf Leak ◽  
Ct Cisternography ◽  
Csf Rhinorrhea ◽  
Cerebrospinal Fluid Rhinorrhea ◽  
Acoustic Neuroma Surgery ◽  
Air Cells ◽  
Mastoid Air Cells

Cerebrospinal fluid (CSF) rhinorrhea after acoustic neuroma surgery is a well-known complication. CT cisternography can be used to demonstrate the entry of CSF from cerebellopontine angle cistern into the mastoid air cells, middle ear and then into nasopharynx via Eustachian tube. We report a case of paradoxical CSF rhinorrhea after surgery for acoustic neuroma in which the path of CSF leak was accurately demonstrated using CT cisternography.

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