Endonasal Endoscopic Repair of Cerebrospinal Fluid Leaks
Keywords:
Endonasal Endoscopic repair, Cerebrospinal Fluid LeaksAbstract
Objective: To assess the outcome of Endonasal Endoscopic Repair of Cerebrospinal Fluid Leaks
Methods and Materials: This study was conducted from July 2013 to October 2014 at the department of Neurosurgery, PGMI, Lahore General Hospital, Lahore. A total of 20 patients were included in this study of both gender (male and female) and in the age range of 15 – 65 years. All the patients undergone Endonasal Endoscopic with the use of a Karl Stortz rigid endoscope of 0º and 30º with a 4mm diameter. All of them were followed up for recurrence of CSF leak and any postoperative complication.
Results: Out of 20 patients, there were 08 (40%) males and 12 (60%) female patients. Their age ranged from 15 – 65 years. The maximum numbers of patients were in their third and fourth decade of life. The cause of CSF leak was spontaneous in 11(55%), iatrogenic in 5 (25%) and traumatic in 4 (20%) of cases. In 13 (65%) patients, CSF rhinorrhea was from right nostril and in 7 (35%) patients left side was affected. Endonasal Endoscopic CSF repair was done in all patients and was successful in 18 (90%) of patients. Two patients (10%) presented with recurrence of CSF leak in which one was successfully re-operated endoscopically and other undergone transcranial approach. Overall the success rate was 95% in our study. Only one patient complicates with meningitis postoperatively which was resolved with antibiotics.
Conclusion: The repair of the CSF rhinorrhea by Endonasal Endoscopic surgery is minimal invasive, safe, effective and is a valid alternative to the cranial approach.
Abbreviations: CSF: Cerebrospinal Fluid. MRI: Magnetic Resonance Imaging.
References
2. Samii M, Draf W: Surgery of the skull base. Berlin: Springer Verlag, 1989: 114-229.
3. Bernal – Sprekelsen M, Bleda Vasquez C, Carrau RL. Ascending meningitis secondary to traumatic cerebrospinal fluid leaks. Am J Rhinol. 2000; 4: 257-259.
4. Ommaya AK. Cerebrospinal fluid rhinorrhea. Neurology, 1964; 15: 106-113.
5. Meco C, Oberascher G, Arrer E, Moser G, Albegger K. Betatrace protein test: new guidelines for the reliable diagnosis of cerebrospinal fluid fistula. Otolaryngol Head Neck Surg. 2003; 129: 508–17.
6. Lloyd MNH, Kimber PM, Burrows EH. Post-traumatic cerebrospinal fluid rhinorrhea: modern high – definition computed tomography is all that is required for the effective demonstration of the site of leakage. Clin Radiol. 1994; 49: 100-103.
7. Locatelli D, Rampa F, Acchiardi I, Bignami M, De Bernardi F, Castelnuovo P. Endoscopic endonasal approaches for repair of cerebrospinal fluid leaks: nine – year experience. Neurosurgery, 2006; 58 (4 Suppl. 2): 246– 56.
8. Aarabi B, Leibrock LG. Neurosurgical approaches to cerebrospinal fluid rhinorrhea. Ear Nose Throat, 1992; 71: 300-305.
9. Lanza DC, O, Brien DA, Kennedy DW. Endoscopic repair of cerebrospinal fluid fistulae and encephaloceles. Laryngoscope, 1996; 106: 1119- 1124.
10. Park J, Strelzow V, Friedman W. Current management of cerebrospinal fluid rhinorrhea. Laryngoscope, 1983; 93: 1294-1300.
11. Dohlman G. Spontaneous cerebrospinal rhinorrhea. Acta Otolaryngol (Stockh), 1948; 67 (Suppl.): 20-23.
12. Wigand ME. Transnasal ethmoidectomy under endoscopical control. Rhinology, 1981; 19 (1): 7–15.
13. Papay FA, Maggiano H, Dominguez S, Hassenbusch SJ, Levine HL, Lavertu P. Rigid endoscopic repair of paranasal sinus cerebrospinal fluid fistulas. Laryngoscope, 1989; 99: 1195-1201.
14. Mattox DE, Kennedy DW. Endoscopic management of cerebrospinal fluid leaks and cephaloceles. Laryngoscope, 1990; 100: 857-862.
15. Stankiewcz JA. Cerebrospinal fluid fistula and endoscopic sinus surgery. Laryngoscope 1991;101:250-256.
16. Cappabianca P, Cavallo LM, Esposito F, De Divitiis O, Messina A, De Divitiis E. Extended endoscopic endonasal approach to the midline skull base: the evolving role of transsphenoidal surgery. Adv Tech Stand Neurosurg. 2008; 33: 151–99.
17. Locatelli D, Rampa F, Acchiardi I, Bignami M, De Bernardi F, Castelnuovo P. Endoscopic endonasal approaches for repair of cerebrospinal fluid leaks: nine – year experience. Neurosurgery, 2006; 58 (4 Suppl. 2): ONS246–56.
18. Dagi FT, George ED. Management of cerebrospinal fluid leaks. In: Schmidek HH, Sweet WH, eds. Operative Neurosurgical Techniques: Indications, Methods and Results. Orlando, FL: Grune and Stratton, 1988: 49–69.
19. Wigand ME. Transnasal ethmoidectomy under endoscopic control. Rhinology, 1981; 19: 7-15.
20. Papay FA, Maggiano H, Dominguez S, Hassenbusch SJ, Levine HL, Lavertu P. Rigid endoscopic repair of paranasal sinus cerebrospinal fluid fistulas. Laryngoscope, 1989; 99: 1195-1201.
21. Mattox DE, Kennedy DW. Endoscopic management of cerebrospinal fluid leaks and cephaloceles. Laryngoscope, 1990; 100: 857-862.
22. Lanza DC, O, Brien DA, Kennedy DW. Endoscopic repair of cerebrospinal fluid fistulae and encephaloceles. Laryngoscope, 1996; 106: 1119-1124.
Downloads
Published
Issue
Section
License
The work published by PJNS is licensed under a Creative Commons Attribution-NonCommercial 4.0 International (CC BY-NC 4.0). Copyrights on any open access article published by Pakistan Journal of Neurological Surgery are retained by the author(s).
