Endoscopic treatment of idiopathic spontaneous although cerebrospinal fluid rhinorrhea: a case report

Year 2009, Volume: 19 Issue: 1, 36 - 40, 01.02.2009

Leyla Kansu Babür Akkuzu Suat Avcı

Abstract

Although cerebrospinal fluid CSF rhinorrhea is a rarely seen clinical entity, it is a condition which should be considered carefully by otolaryngologists and neurosurgeons because it has the possibility of serious complications unless it is treated. Trauma is the most common causative factor. Idiopathic spontaneous CSF rhinorrhea is a very rare entity which is difficult to manage and which hashigh recurrence rates. Although in the past CSF rhinorrhea used to be treated by intracranial route, nowadays endonasal endoscopic surgery is preferred because of wide usage of rigid endoscopes with much fewer complications, In this article, a case of 43-year-old female with idiopathic spontaneous CSF rhinorrhea repaired by endonasal endoscopic surgery is presented, and the diagnosis and the treatment of CSF rhinorrhea is reviewed.

Keywords

Beta-2-transferrin, cerebrospinal fluid rhinorrhea, spontaneous, cisternography, computed tomography, endoscopic surgical procedure

İdyopatik spontan beyin omurilik sıvısı rinorenin endoskopik tedavisi: Olgu sunumu

Abstract

Beyin omurilik sıvısı BOS rinore nadiren görülmesi- ne karşın tedavi edilmediği takdirde ciddi komplikas- yonlara yol açabilmesi nedeni ile beyin cerrahisi ve kulak burun boğaz hekimlerinin dikkatle yaklaşması gereken klinik bir durumdur. Oluşma nedeni genel- likle travmadır. Nadir görülen idyopatik spontan BOS rinorenin, tedavisi zor ve yineleme oranı yüksektir. Beyin omurilik sıvısı rinorenin tedavisinde, geçmişte intrakraniyal yaklaşım uygulanmasına karşın, rijit endoskopların yaygın olarak kullanıma girmesi ve komplikasyonlarının daha az olması nedeniyle günü- müzde endonazal endoskopik cerrahi yaklaşım tercih edilmektedir. Bu çalışmada, endonazal endoskopik yaklaşımla tedavi edilen 43 yaşında bir kadın idyo- patik spontan BOS rinore olgusu sunuldu ve BOS rinorenin tanı ve tedavisi tekrar gözden geçirildi

Keywords

Beta-2-transferrin, beyin omurilik sıvısı rinore, spontan, sisternografi, bilgisayarlı tomografi, endoskopik tedavi

References

• Applebaum EL, Chow JM. Cerebrospinal fluid leaks. In: Cummings CW, Fredrickson JM, Harker LA, Krause CJ, Richardson MA, Schuller DE, editors. Otolaryngology Head and Neck Surgery. 3rd ed. St. Louis: Mosby; 1998. p. 1189-98.
• Dunn CJ, Alaani A, Johnson AP. Study on spontane- ous cerebrospinal fluid rhinorrhoea: its aetiology and management. J Laryngol Otol 2005;119:12-5.
• Hegazy HM, Carrau RL, Snyderman CH, Kassam A, Zweig J. Transnasal endoscopic repair of cerebrospinal fluid rhinorrhea: a meta-analysis. Laryngoscope 2000; 110:1166-72.
• Wise SK, Schlosser RJ. Evaluation of spontaneous nasal cerebrospinal fluid leaks. Curr Opin Otolaryngol Head Neck Surg 2007;15:28-34.
• Martin TJ, Loehrl TA. Endoscopic CSF leak repair. Curr Opin Otolaryngol Head Neck Surg 2007;15:35-9.
• Lee TJ, Huang CC, Chuang CC, Huang SF. Transnasal endoscopic repair of cerebrospinal fluid rhinorrhea and skull base defect: ten-year experience. Laryngoscope 2004;114:1475-81.
• McMains KC, Gross CW, Kountakis SE. Endoscopic management of cerebrospinal fluid rhinorrhea. Laryngoscope 2004;114:1833-7.
• Schlosser RJ, Bolger WE. Significance of empty sella in cerebrospinal fluid leaks. Otolaryngol Head Neck Surg 2003;128:32-8.
• Casiano RR, Jassir D. Endoscopic cerebrospinal fluid rhinorrhea repair: is a lumbar drain necessary? Otolaryngol Head Neck Surg 1999;121:745-50.
• Mirza S, Thaper A, McClelland L, Jones NS. Sinonasal cerebrospinal fluid leaks: management of 97 patients over 10 years. Laryngoscope 2005;115:1774-7.
• Schmerber S, Righini C, Lavielle JP, Passagia JG, Reyt E. Endonasal endoscopic closure of cerebrospinal fluid rhinorrhea. Skull Base 2001;11:47-58.
• Ohtakara K, Matsubara T, Kojima T, Taki W, Waga S. Cerebrospinal fluid rhinorrhea associated with untreated prolactinoma-case report. Neurol Med Chir (Tokyo) 2000;40:413-8.
• Zweig JL, Carrau RL, Celin SE, Schaitkin BM, Pollice PA, Snyderman CH, et al. Endoscopic repair of cere- brospinal fluid leaks to the sinonasal tract: predictors of success. Otolaryngol Head Neck Surg 2000;123:195- 201.
• Wigand ME. Transnasal ethmoidectomy under endo- scopic control. Rhinology 1881;19:7-5.