A OBSERVATIONAL STUDY OF ENDOSCOPIC REPAIR OF CSF RHINORRHOEA

Background: Intrathecal fluorescein may be used to visualize CSF fistulas using a nasal endoscope. This allows the examiner to directly visualize the size of the defect, its location, and its rate of flow. The first repair of CSF leak was performed by Dandy in 1926 using a frontal craniotomy. This technique had a 60-80% success rate and was the gold standard for decades. In 1964Vrabec and Hallberg described the endonasal approach of CSF leak repair. AIMS: This study aims to establish the success rate of endoscopic surgical repair of CSF rhinorrhoca. MATERIALS AND METHODS: The study was conducted in Department of ENT IPGMER and SSKM Hospital. During the study period of 18 months, 30 patients have been admitted in our department with CSF leak (most of them were referred from neurosurgery). RESULTS: Fat and fascia lata and temporalis fascia were used to repair CSF leak in 24 patients. Bath plug technique was applied for 3 patients. Repair with vascularised flap such as Hadad flap or middle turbinate graft were used in case of 3 patients. CSF rhinorrhoea repair was successful in 28 out of 30(94%) patients after primary surgery whereas recurrence occurred in 2(6%) cases. Among them 1 patient underwent second surgery which achieved definitive closure of the leak. But one case lost follow up and did not come for second surgery. Interval between surgery and recurrence was varied and so were the causes. CONCLUSION: CSF rhinorrhoea cases can be repaired by an endoscopic approach with a high success rate. Radiological investigation of PNS and brain are equally important for selection of cases for endoscopic repair. Spontaneous leak must be checked cautiously to exclude features of raised ICT. Relapse occurs mainly for failure to delineate actual site or sites of leak and inadequate size or faulty placement of graft. Success depends not only on surgical skill but also on baseline intracranial tension, cause & site of leak and postoperative care.

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

Birat Journal of Health Sciences ◽

10.3126/bjhs.v6i1.37558 ◽

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.

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Trans-nasal endoscopic repair of cerebrospinal fluid rhinorrhoea: a retrospective analysis

International Journal of Otorhinolaryngology and Head and Neck Surgery ◽

10.18203/issn.2454-5929.ijohns20184354 ◽

2018 ◽

Vol 4 (6) ◽

pp. 1372

Author(s):

Amardeep Singh ◽

Navneet Kumar ◽

Sarvpreet Singh Grewal

Keyword(s):

Surgical Outcomes ◽

Tertiary Care ◽

Middle Turbinate ◽

Csf Leak ◽

Graft Material ◽

Care Hospital ◽

Hospital Data ◽

Endoscopic Repair ◽

Csf Rhinorrhoea ◽

Rate Of Success

Background: The purpose of present study was to assess the management and surgical outcomes of trans-nasal endoscopic repair of CSF rhinorrhoea.Methods: A retrospective study was conducted on the basis of medical records of 8 patients (6 males and 2 females) who had undergone trans-nasal endoscopic reconstructive surgery for CSF leak in a tertiary care hospital. Data so collected was analyzed to determine the demographic and diagnostic factors with surgical outcomes. Rate of success achieved was also assessed. Results: Majority of patients were in the age group of 21-40 years with mean age of 28.50 years. Main cause of leak was trauma (75%) and most common site of defect was found to be the cribriform plate of ethmoid bone (75%). 38% patients suffered from recurrent episodes of meningitis. Repair of dehiscence was done by variety of graft material like fat, fascia, middle turbinate mucosa, septal bone, cartilage or mucosa and fibrin glue. Success rate of 100% was observed. No post-surgical complications were encountered in this series.Conclusions: Trans-nasal endoscopic surgical technique is an effective and atraumatic procedure for repair of CSF rhinorrhoea with minimum morbidity and low post-operative complications.

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Endoscopic Repair of Cerebrospinal Fluid Rhinorrhea: Learning from Our Failures

American Journal of Rhinology ◽

10.1177/194589240101500509 ◽

2001 ◽

Vol 15 (5) ◽

pp. 333-342 ◽

Cited By ~ 52

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.

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Endoscopic cerebrospinal fluid leak repair: how we do it

International Journal of Otorhinolaryngology and Head and Neck Surgery ◽

10.18203/issn.2454-5929.ijohns20192713 ◽

2019 ◽

Vol 5 (4) ◽

pp. 965

Author(s):

Kalpesh Patel ◽

Abhishek Gugliani ◽

Rajesh Vishwakarma

Keyword(s):

Cerebrospinal Fluid ◽

Cerebrospinal Fluid Leak ◽

Subsequent Treatment ◽

Csf Leak ◽

Open Approach ◽

Endoscopic Repair ◽

Civil Hospital ◽

Medical College ◽

Endoscopic Method ◽

Csf Rhinorrhoea

Background: Cerebrospinal fluid (CSF) rhinorrhoea is characterized by a defect in the barriers which separate the subarachnoid space from sinonasal tract resulting in the leakage of watery fluid from the nose. Management of CSF rhinorrhoea is by both conservative and/or surgical approach. Transnasal endoscopic method has become the preferred surgical method for the repair of CSF leak because of less complication as compared to the open approach. To evaluate the results of patients who underwent endoscopic repair of CSF rhinorrhoea over a period of 5 years at BJ Medical College, Civil Hospital, Ahmedabad.Methods: 118 patients were included in this retrospective study who underwent CSF leak repair by nasal endoscopy over a period of 5 years between 2011-2016 in the department of ENT at BJ Medical College, Civil Hospital, Ahmedabad. As per review of the records, these patients were diagnosed with CSF leak on the basis of their history, clinical examination, and radiological investigations. Materials used for the repair were fat, fascia lata, fibrin sealant, and/or vascular flap. Results: Primary surgery was successful in 110 (93%) of cases. In 8 (7%) cases, there was a recurrence of leak which was managed by either conservative management (5 cases, 4%) or by re-exploration (3 cases, 3%).Conclusions: Transnasal endoscope is an important tool for the evaluation and subsequent treatment of CSF rhinorrhoea. Endoscopic repair of CSF rhinorrhoea is safe, effective, has a low complication rate and has almost completely replaced the open technique.

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Endoscopic Repair of Spontaneous CSF Rhinorrhoea: Results from 21 Cases

Bengal Journal of Otolaryngology and Head Neck Surgery ◽

10.47210/bjohns.2020.v28i1.180 ◽

2020 ◽

Vol 28 (1) ◽

pp. 71-75

Author(s):

Swapan Kumar Ghosh ◽

Indranath Kundu ◽

Mukesh Kumar Singh ◽

Rajarshi Chakraborty ◽

Suyash Banerjee

Keyword(s):

Tertiary Care ◽

Treatment Strategies ◽

Csf Leak ◽

Endoscopic Repair ◽

Endoscopic Endonasal ◽

Prospective Longitudinal Study ◽

Tertiary Care Institution ◽

Csf Rhinorrhoea ◽

Skull Base Defect ◽

Prospective Longitudinal

Introduction Surgery to close the skull base defect is the treatment of choice in persistent spontaneous cerebrospinal fluid rhinorrhoea with endoscopic endonasal repair being the method of choice. This study analysed the demographics of presentation, optimal diagnostic and localisation strategies and the effectiveness of transnasal endoscopic treatment strategies with post-operative follow-up of CSF rhinorrhoea patients in a tertiary care institution . Materials and Methods A prospective longitudinal study was conducted on 21 CSF rhinorrhoea patients operated on between August 2014 and August 2018 and results documented. Results CSF rhinorrhoea was found most commonly in middle aged female patients in our study. HRCT PNS was capable of identifying a leak site in 66% of the cases. All patients were operated endoscopically with no major intra-operative or post-operative complications. Resolution of CSF leak occurred in 85% of cases. Conclusion CSF rhinorrhoea can be diagnosed and endoscopic repair can be effectively performed in our existing tertiary care set-ups with good results.

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The endoscopic treatment of cerebrospinal fluid rhinorrhoea: the Nottingham experience

The Journal of Laryngology & Otology ◽

10.1017/s0022215100136643 ◽

1997 ◽

Vol 111 (2) ◽

pp. 125-128 ◽

Cited By ~ 48

Author(s):

R. G. M. Hughes ◽

N. S. Jones ◽

I. J. A. Robertson

Keyword(s):

Cerebrospinal Fluid ◽

Subsequent Treatment ◽

Endoscopic Approach ◽

Csf Leak ◽

Endoscopic Repair ◽

Closure Rate ◽

Endoscopic Techniques ◽

Csf Rhinorrhoea ◽

Skull Base Defect

AbstractThe conventional neurosurgical management of cerebrospinal fluid (CSF) rhinorrhoea has been by intracranial access. Otorhinolaryngologists have undertaken extracranial approaches where access has been possible, and more recently an endoscopic approach has been advocated. We report 17 patients with confirmed CSF rhinorrhoea treated with endoscopic techniques between 1993 and 1996. Follow-up ranged from four to 32 months and showed an overall closure rate of 16 out of 17 patients with no complications. No patient undergoing primary endoscopic repair developed anosmia. The use of fluorescein helped localize the site of the CSF leak in four patients in whom the computed tomography (CT) scan had not identified the site of the defect.We conclude that the endoscope is a valuable tool in the evaluation and subsequent treatment of CSF rhinorrhoea. Where the skull base defect is accessible to the endoscope, we propose that an endoscopic approach should be considered as the preferred method.

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The management of massive pneumocephalus and cerebrospinal fluid rhinorrhoea as a consequence of biopsy in a patient with inverted papilloma

The Journal of Laryngology & Otology ◽

10.1017/s0022215100141374 ◽

1998 ◽

Vol 112 (7) ◽

pp. 657-659 ◽

Cited By ~ 3

Author(s):

U. S. Kale ◽

S. G. Raje ◽

R. G. Wight

Keyword(s):

Cerebrospinal Fluid ◽

Nasal Polyps ◽

Inverted Papilloma ◽

Successful Outcome ◽

Csf Leak ◽

Lateral Rhinotomy ◽

Endoscopic Repair ◽

Cerebrospinal Fluid Rhinorrhoea ◽

Csf Rhinorrhoea

AbstractNasal polypectomy is a common ENT operation. Cerebrospinal fluid (CSF) rhinorrhoea and pneumocephalus are rare complications. We present a patient who developed both these complications after biopsy of nasal polyps which subsequently proved to be an inverted papilloma. He had a defect in the ethmoid roof, which was repaired.Whilst endoscopic repair of CSF leak is increasing in popularity, in this patient because of his pathology and difficulty of access a more traditional lateral rhinotomy approach was made with a successful outcome. An overview of the management of these complications is presented.

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

Clinical Rhinology An International Journal ◽

10.5005/jp-journals-10013-1193 ◽

2014 ◽

Vol 7 (2) ◽

pp. 47-51 ◽

Cited By ~ 1

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.

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Rhinorrhoea feigning cerebrospinal fluid leak: nine illustrative cases

The Journal of Laryngology & Otology ◽

10.1258/0022215001905850 ◽

2000 ◽

Vol 114 (6) ◽

pp. 462-464 ◽

Cited By ~ 24

Author(s):

N. Bateman ◽

N. S. Jones

Keyword(s):

Cerebrospinal Fluid ◽

Lumbar Puncture ◽

Correct Diagnosis ◽

Cerebrospinal Fluid Leak ◽

Csf Leak ◽

Bony Defect ◽

High Resolution Computed Tomography ◽

Radiological Investigation ◽

Csf Rhinorrhoea ◽

Beta 2

Before contemplating surgery for cerebrospinal fluid (CSF) rhinorrhoea it is vital that the correct diagnosis is established. This can be done using immunofixation of beta-2-transferrin, that is nearly always positive in cases of CSF rhinorrhoea. Fluorescein lumbar puncture is useful in establishing the exact site of a leak and also in confirming the absence of a leak where the clinical suspicion is high but the beta-2-transferrin is negative. High resolution computed tomography (CT) scanning is a useful radiological investigation for identifying a bony defect. We present nine patients who presented with clear rhinorrhoea that was clinically highly suggestive of a CSF leak. Three of these patients had undergone previous craniotomies for presumed CSF rhinorrhoea. The diagnosis of CSF rhinorrhoea was excluded in all patients using beta-2-transferrin with or without fluorescein lumbar puncture. The authors believe that measurement of beta-2-transferrin should be mandatory before surgery for CSF rhinorrhoea.

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Transnasal Endoscopic Repair of Cerebrospinal Fluid Rhinorrhea

Clinical Rhinology An International Journal ◽

10.5005/jp-journals-10013-1305 ◽

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.

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