Chapter-077 Endoscopic Repair of CSF 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.

Download Full-text

Surgically repaired posttraumatic CSF rhinorrhea: An institutional experience and review of literature

Indian Journal of Neurosurgery ◽

10.4103/2277-9167.94366 ◽

2012 ◽

Vol 01 (01) ◽

pp. 023-027

Author(s):

Brijesh Kumar ◽

Rabinarayan Sahu ◽

A.K. Srivastava ◽

Anup Nair ◽

Anant Mehrotra ◽

...

Keyword(s):

Skull Base ◽

Early Onset ◽

Review Of Literature ◽

Endoscopic Repair ◽

Csf Rhinorrhea ◽

Skull Base Fracture ◽

Institutional Experience ◽

History Of ◽

Extradural Approach ◽

Better Than

AbstractPosttraumatic cerebrospinal fluid (CSF) rhinorrhea frequently complicates anterior skull base fracture. Although skull base fracture is present in only about 7% cases of head injury, CSF rhinorrhea develops in 30% of cases with basal fracture.A total of 43 cases admitted in our Institute (SGPGI Lucknow) from January 2000 to June 2011with history of head trauma followed by CSF rhinorrhea. Forty one cases were included in this study as two patients refused surgery.Out of forty one cases, 26 cases (63%) were admitted with history of recurrent meningitis, 21 cases (51%) with loss of smell, 26 cases (63%) with delayed onset CSF rhinorrhea, 3 cases (7%) with early onset rhinorrhea which did not improve after trauma, 12 cases (30%) with early onset rhinorrhea which improved but reappeared after some time. Twenty cases (48.8%) were repaired by extradural approach, 10 cases (24.4%) were repaired by intradural approach and 11 cases (26.8%) were repaired by endoscopic approach. 12 cases (29.0%) required re-surgery for persistent or recurrence of CSF rhinorrhea.Although posttraumatic CSF rhinorrhea usually resolves with conservative management, its persistence makes an individual prone for further complications like meningitis, brain abscess and septicaemia. Timely surgical intervention usually gives promising results. Endoscopic repair was better than transcranial repair.

Download Full-text

Endoscopic management of spontaneous meningoencephalocele of the lateral sphenoid sinus

Journal of Neurosurgery ◽

10.3171/2009.7.jns0842 ◽

2010 ◽

Vol 112 (5) ◽

pp. 1070-1077 ◽

Cited By ~ 46

Author(s):

Abtin Tabaee ◽

Vijay K. Anand ◽

Paolo Cappabianca ◽

Aldo Stamm ◽

Felice Esposito ◽

...

Keyword(s):

Surgical Technique ◽

Sphenoid Sinus ◽

Clinical Manifestations ◽

Early Postoperative Period ◽

Endoscopic Management ◽

Endoscopic Repair ◽

Endoscopic Endonasal ◽

Csf Rhinorrhea ◽

Endoscopic Closure ◽

Postoperative Meningitis

Object Spontaneous meningoencephaloceles of the lateral sphenoid sinus are rare lesions that are hypothesized to result from persistence of the lateral craniopharyngeal canal. Prior reports of the management of this lesion have been limited by its relative rarity. The objective of this paper is to report the theoretical etiology, surgical technique, and outcomes in patients undergoing endoscopic repair of spontaneous meningoencephalocele of the sphenoid sinus. Methods The authors conducted a retrospective review of a multiinstitutional series of 13 cases involving patients who underwent endoscopic repair of spontaneous meningoencephalocele of the lateral sphenoid sinus. The surgical technique and pathophysiological considerations are discussed. Results The clinical manifestations included CSF rhinorrhea (85%), chronic headache (77%), and a history of meningitis (15%). The endoscopic approaches to the lateral sphenoid sinus were transnasal (39%), transpterygoid (23%), and transethmoid (39%). Two patients (8%) had postoperative CSF leaks, one of which closed spontaneously and one of which required revision endoscopic closure. All patients were free of leak at most recent follow-up. One patient experienced postoperative meningitis in the early postoperative period. Conclusions Endoscopic endonasal closure is an effective modality in the treatment of spontaneous meningoencephaloceles of the lateral sphenoid sinus. If the sphenoid sinus has extensive lateral pneumatization, adequate exposure may require a transpterygoid approach.

Download Full-text

A retrospective study to analyze treatment of post traumatic cerebro spinal fluid rhinorrhea and role of trans cranial pedicled pericranial repair in present day context

IP Indian Journal of Anatomy and Surgery of Head Neck and Brain ◽

10.18231/j.ijashnb.2021.029 ◽

2022 ◽

Vol 7 (4) ◽

pp. 111-118

Author(s):

Shashivadhanan ◽

Abhishek Mishra

Keyword(s):

Retrospective Study ◽

Skull Base ◽

Tertiary Care Hospital ◽

Tertiary Care ◽

Spinal Fluid ◽

Csf Leak ◽

Care Hospital ◽

Endoscopic Repair ◽

Csf Rhinorrhea ◽

Post Traumatic

: Skull base fractures are a major cause of morbidity and mortality in head injury. Anterior cranial Fossa (ACF) skull base fracture, leading to Cerebro Spinal Fluid (CSF) Rhinorrhea is one of the most commonly encountered presentation in ACF base fractures. The key to successful management of such cases lies in early diagnosis and surgical management before it leads to meningitis and avoidable mortality.To evaluate the cases of post traumatic CSF rhinorrhea and analyze the parameters utilized to guide the management strategies. An attempt was made to come up with guidelines for its management in a tertiary care hospital.This was a retrospective study in which all cases of traumatic CSF Rhinorrhea admitted to Tertiary care hospital were included. Patients were divided into three groups. First group was conservatively managed in which the rhinorrhea and serial imaging findings showed favourable response.In thesecond group patients were subjected to endoscopic repair by the ENT surgeon based on anatomical considerations. The third group included patients who were had failed the trial of conservative management and the site of leak did not favor endoscopic repair.The outcomes in all these groups were analyzed and conclusions drawn.A total of 54 patients were included in the study which was conducted between Jan 2014 to 2020. 24 were successfully managed conservatively,10 were managed with endoscopic repair and 20 were managed by bifrontal craniotomy and pedicled pericranial ACF Base repair. There was one case from the first group who developed CSF leak after one month necessitating ACF base repair. There was no recurrence reportedin the cases managed endoscopically, whereas one case subjected to craniotomy had recurrence requiring lumbar drain placement. With each transcranial surgery there was a refinement in the technique further minimizing complications. We have elaborated on the surgical nuances to ensurebetter outcomes. : Pedicledpericranial flap ACF base repair is an elegant approach which requires an understanding of the mechanism of CSF leak from skull base fractures. This procedure can easily be mastered and when performed correctly provides best results for cases where there are multiple ACF defects, those not accessible by endoscope and also in those cases where imaging is not able to localize the exact site of defect leading to CSF rhinorrhea. Anosmia is an in evitable complication of this procedure. However, the trade off between mortality resulting from meningitis versus anosmia makes it a viable and attractive treatment option.

Download Full-text

Endoscopic repair of CSF rhinorrhea: experience of 44 cases

Brazilian Journal of Otorhinolaryngology ◽

10.1016/s1808-8694(15)31202-7 ◽

2005 ◽

Vol 71 (4) ◽

pp. 472-476 ◽

Cited By ~ 4

Author(s):

Bernardo Cunha Araujo Filho ◽

Ossamu Butugan ◽

Francini Grecco de Melo Pádua ◽

Richard Louis Voegels

Keyword(s):

Endoscopic Repair ◽

Csf Rhinorrhea

Download Full-text

Endoscopic repair of CSF rhinorrhea: Necessity of fibrin glue

Neurology India ◽

10.4103/0028-3886.117619 ◽

2013 ◽

Vol 61 (4) ◽

pp. 396 ◽

Cited By ~ 2

Author(s):

Satyawati Mohindra ◽

Sandeep Mohindra ◽

Karan Gupta

Keyword(s):

Fibrin Glue ◽

Endoscopic Repair ◽

Csf Rhinorrhea

Download Full-text

Cerebrospinal Fluid Rhinorrhea: The Place for Endoscopic Surgery

Clinical Rhinology An International Journal ◽

10.5005/jp-journals-10013-1018 ◽

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.

Download Full-text

Endonasal Endoscopic Management of Frontal Sinus Cerebrospinal Fluid Leak

American Journal of Rhinology and Allergy ◽

10.2500/ajra.2017.31.4478 ◽

2017 ◽

Vol 31 (6) ◽

pp. 406-411 ◽

Cited By ~ 7

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.

Download Full-text

Outcome of Endoscopic Repair of CSF Rhinorrhea with Endonasal Endoscopic Approach in terms of Success of Repair.

Pakistan Journal Of Neurological Surgery ◽

10.36552/pjns.v23i4.378 ◽

2019 ◽

Vol 23 (4) ◽

Author(s):

Muhammad Ishfaq ◽

Talha Abbas ◽

Muhammad Akmal ◽

Nabeel Choudhry ◽

Adeeb Ul Hassan ◽

...

Keyword(s):

Age Groups ◽

Case Series ◽

Endoscopic Approach ◽

Endoscopic Repair ◽

Csf Rhinorrhea ◽

Female Patients ◽

Significant Difference ◽

Post Traumatic ◽

Gender Groups ◽

Successful Repair

Objective: This descriptive case series conducted to evaluate the outcome of CSF rhinorrhea repair with the Endonasal Endoscopic approach in terms of success of the repair.Materials and Methods: The study was conducted at Neurosurgery department, Unit II, Punjab institute of neurosciences, Lahore. This study involved 40 patients aged between 3-80 years of both genders diagnosed of CSF rhinorrhea with presented with in 1 week after trauma and spontaneous and postoperative cases.Results: The age of the patients ranged from 5 years to 53 years with a mean of 22.75 ± 15.59 years. Total 30 (75%) male and 10 (25%) female patients are included in the study. The underlying etiology was found to be post-traumatic (67.5%) 27 cases, followed by post-operative in 7 (17.5%) and spontaneous in 6 (15.0%) cases. Successful repair was observed in 36 (90.0%). No significant difference was found in the frequency of successful repair among various age groups; 5-20, 21-36 and 37-53 years (95.7%, 83.3% and 81.8%; p = 0.381), gender groups; male verses female (86.2% and 100.0%; p = 0.194) and etiological groups; post-traumatic vs. post-operative vs. spontaneous (92.6% vs. 71.4% vs. 100.0%; p = 0.169).Conclusions: The frequency of successful repair was found to be 90% in patients of CSF rhinorrhea treated through Endonasal endoscopic approach. No statistically significant difference was found in successful repair frequency across patient’s gender, age and underlying cause of CSF rhinorrhea.

Download Full-text

Spontaneous CSF Leaks and Meningoencephaloceles: Endoscopic Repair and Possible Etiology

Otorhinolaryngology Clinics - An International Journal ◽

10.5005/jp-journals-10003-1074 ◽

2011 ◽

Vol 3 (3) ◽

pp. 151-155

Author(s):

Andrey S Lopatin ◽

Dmitry N Kapitanov ◽

Alexander A Potapov

Keyword(s):

Success Rate ◽

Endoscopic Surgery ◽

Sphenoid Sinus ◽

Lateral Part ◽

Nasal Discharge ◽

Bony Defect ◽

Endoscopic Repair ◽

Csf Rhinorrhea ◽

Etiological Factors ◽

Csf Fistula

ABSTRACT Objective To assess the outcomes of endonasal endoscopic repair of spontaneous cerebrospinal fluid (CSF) rhinorrhea and to analyze its possible etiological factors. Patients During the period between January 1999 and November 2011, 173 patients who presented with spontaneous CSF rhinorrhea underwent endonasal endoscopic surgery. Preoperative examination included CT scans, nasal endoscopy, measurement of glucose concentration in the nasal discharge and, in some cases, cisternographic evaluation via CT or MRI. CSF fistula closure was performed using endonasal endoscopic technique under general anesthesia. In all, 186 surgeries (173 primary attempts and 13 revisions) were carried out over the 12-year period. A combination of different plastic materials, i.e. nasal septum cartilage, facia lata, abdominal fat, rotating middle turbinate flaps, and fibrin glue was used for fistula repair. Results At the time of the surgery, sites of the CSF fistula were determined as follows: Cribriform plate—70, fovea ethmoidalis—55, sphenoid sinus—45, frontal sinus—3. Extremely pneumatized lateral extension of the sphenoid sinus was found in 26 patients, and a meningo/encephalocele protruding through the bony defect was the source of the leak in 23 of them. In terms of up to 11 years, 165 patients were treated successfully after first attempt and five more recovered after revision endoscopic surgery. Success rate after the first surgery was 95.4%, overall success rate—97.7%. There were no postoperative complications. Conclusion Possible etiological factors of this disease include obesity, innate skull base malformations, overpneumatized sphenoid sinus, particularly presence of its lateral extensions and the empty sella syndrome. Endoscopic endonasal repair of spontaneous CSF rhinorrhea appears to be a safe and successful procedure. However, technique of endoscopic closure of CSF fistulas in the lateral part of the sphenoid sinus needs further perfection.

Download Full-text