Abstract
Objective: To evaluate the clinical effect of endoscopic surgery for cerebrospinal fluid (CSF) rhinorrhea and discuss the best treatment.
Method: Records of 52 patients aged 19 to 60 years with a mean age of 41.9 years treated by endoscopic surgery in our department between June 2002 to May 2010 were analyzed retrospectively. Eighteen were spontaneous, 34 were traumatic or iatrogenic. Middle turbinate mucosa, fascia lata, and abdominal fat were used in the leak repair. The CSF fistula were closed by the combined multilayer “underlay,” “overlay” or “bath-plug” techniques.
Results: The cribriform plate was the most common site of the leak (21/52), followed by the sphenoid sinus (17/52), anterior ethmoid sinus (7/52), posterior ethmoid sinus (4/52), and frontal recess (3/52). Defects ranged in size from 5 to 35 mm (mean, 9.7 ± 3.5mm), 13 cases were >10 mm. Forty-two cases (80.8%) were repaired successfully at the first transnasal endoscopic surgery, 6 cases succeeded at the second attempt, and 4 cases at the third attempt. The first attempt success rate of patients with large size (>10 mm) leaks (61.5%) was significantly lower than that of patients with small size (<10 mm) leaks (87.2%). One patient had postoperative intracranial infection and one patient had postoperative hydrocephalus. All patients were followed-up for 6 months to 3 years (mean 1.2 years), and no recurrence was found.
Conclusion: Endoscopic closure of CSF rhinorrhea represents a minimally invasive and highly successful procedure. Location and size of leak and repair material affect surgical outcome. Abdominal fat is a good repair material to stop the leak for patients with larger (>10 mm) leaks.
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