Endoscopic Cerebral Spinal Fluid (CSF) Rhinorrhea: Clinical Experiences

Year 2018, Volume: 1 Issue: 1, 1 - 4, 01.04.2018

Sevinç Eraslan Sercan Göde , Umut Erdoğan , İsa Kaya , Raşit Midilli , Halil Karcı

Abstract

Objective: We present our experience of endoscopic repair of cerebrospinal fluid (CSF) rhinorrhea.
Material and Methods: This was a retrospective study including 46 patients with CSF rhinorrhea, who were mana- ged using endoscopy at the Otorhinolaryngology Department of Ege University Hospital, between March 2010 and November 2016. The cause of CSF rhinorrhea, localization and size of the defect, repair style, and recurrence were investigated.
Results: Etiologically, 30 patients were traumatic and 16 were nontraumatic. Overall, 23% patients had a history of meningitis before admission to our clinic. The ethmoid roof, sphenoid sinus, and frontal recess were the commonest regions of defects. There was recurrence in 5 patients who were endoscopically managed.
Conclusion: Because of the advances in endoscopic sinus surgery, endoscopic intracranial procedures, and anterior skull base surgery, otorhinolaryngologists could frequently diagnose CSF rhinorrhea. Appropriate management and endoscopic techniques led to successful results.
Keywords: Cerebrospinal fluid rhinorrhea, endonasal endoscopic surgical procedures, spontaneous cerebrospinal fluid leaks, endoscopic repair, endoscopic anterior skull base, repair

Keywords

Cerebrospinal fluid rhinorrhea , endonasal endoscopic surgical procedures , spontaneous cerebrospinal fluid leaks , endoscopic repair , endoscopic anterior skull base , repair

References

• 1. Shetty PG, Shroff MM, Sahani DV, Kirtane MV. Evaluationof high-resolution CT and MR cisternography in the diagnosis of cerebrospinal fluid fistula. AJNR Am J Neuroradiol 1998; 19: 633-9.
• 2. Har-El G. What is ‘‘spontaneous’’ cerebrospinal fluid rhinorrhea? Classification of cerebrospinal fluid leaks. Ann Otol Rhinol Laryngol 1999; 108: 323-6. [CrossRef ] 3. Prosser JD, Vender JR, Solares CA. Traumatic cerebrospinal fluid leaks. Otolar- yngol Clin North Am 2011; 44: 857-73. [CrossRef ]
• 4. Schlosser RJ, Bolger WE. Endoscopic management of cerebrospinal fluid rhi- norrhea. Otolaryngol Clin North Am 2006; 39: 523-38. [CrossRef ]
• 5. Banks CA, Palmer JN, Chiu AG, O’Malley BW Jr, Woodworth BA, Kennedy DW. Endoscopic closure of CSF rhinorrhea: 193 cases over 21 years. Otolaryngol Head Neck Surg 2009; 140: 826-33. [CrossRef ]
• 6. Tabaee A, Kassenoff TL, Kacker A, Anand VK. The efficacy of computer assist- ed surgery in the endoscopic management of cerebrospinal fluid rhinorrhea. Otolaryngol Head Neck Surg 2005; 133: 936-43. [CrossRef ]
• 7. Zuckerman JD, Del Gaudio JM. Utility of preoperative high-resolution CT and intraoperative image guidance in identification of cerebrospinal fluid leaks for endoscopic repair. Am J Rhinol 2008; 22: 151-4. [CrossRef ]
• 8. Yeates AE, Blumenkopf B, Drayer BP, Wilkins RH, Osborne D, Heinz ER. Sponta- neous CSF rhinorrhea arising from the middle cranial fossa: CT demonstration. AJNR Am J Neuroradiol 1984; 5: 820-1.
• 9. Nandapalan V, Watson ID, Swift AC. Beta-2 transferrin and cerebrospinal fluid rhinorrhoea. Clin Otolaryngol 1996; 21: 259-64. [CrossRef ]
• 10. Hegazy HM, Carrau RL, Snyderman CH, Kassam A, Zweig J. Transnasal endo- scopic repair of cerebrospinal fluid rhinorrhea: ameta-analysis. Laryngoscope 2000; 110: 1166-72. [CrossRef ]
• 11. Psaltis AJ, Schlosser RJ, Banks CA, Yawn J, Soler ZM. A systematic review of the endoscopic repair of cerebrospinal fluid leaks. Otolaryngol Head Neck Surg 2012; 147: 196-203. [CrossRef ]
• 12. Ada M, Öktem F, Toprak M, Erem M. Bir Vaka Dolayısıyla BOS Rinoreli Hastaya Yaklaşım. Turk Arch ORL 1999; 37: 125-8.
• 13. El Gammal T, Sobol W, Wadlington VR, Sillers MJ, Crews C, Fisher WS, et al. Cere- brospinal fluid fistula: detectionwith MR cisternography. AJNR Am J Neurora- diol 1998; 19: 627-31.
• 14. Giovannetti F, Ruggeri A, Buonaccorsi S, Pichierri A, Valentini V. Endoscopic en- donasal approaches for cerebrospinal fluid leaks repair. J Craniofac Surg 2013; 24: 548-53. [CrossRef ]
• 15. Castelnuovo P, Dallan I, Pistochini A, Battaglia P, Locatelli D, Bignami M. En- donazal endoscopic repair of Sternberg’s canal cerebrospinal fluid leaks. La- ryngoscope 2007; 117: 345-9. [CrossRef ]
• 16. Stone JA, Castillo M, Neelon B, Mukherji SK. Evaluation of CSF leaks: high-reso- lution CT compared with contrastenhanced CT and radionuclide cisternogra- phy. AJNR Am J Neuroradiol 1999; 20: 706-12.