Outcomes and Complications of Endoscopic Endonasal Repair for Spontaneous CSF Rhinorrhea: A Four-Year Experience of 85 Cases

Abstract

Objective: This study evaluated outcomes of an endoscopic endonasal multilayer repair protocol for spontaneous CSF rhinorrhea at two major tertiary centers in Khyber Pakhtunkhwa, Pakistan.

Materials & Methods:  This retrospective descriptive case series included 85 patients with spontaneous CSF rhinorrhea who underwent endoscopic endonasal multilayer repair over four years at two tertiary hospitals in KP, Pakistan. Diagnosis was confirmed by clinical evaluation, CSF analysis, and prone-position contrast MRI, supplemented by CT. Repair was defect-size-based: nasoseptal flap for 1-2 cm/high-flow defects (31.8%), middle turbinate flap for 7-10 mm/moderate-flow defects (35.3%), and fascia lata/fat graft for 3-6 mm/low-flow defects (32.9%). Fibrin glue was used selectively in high-risk cases; lumbar drains were used for high-flow leaks.

Results:  Among 85 patients (mean age 39±14.3 years; 68.2% female; mean BMI 28±3.6 kg/m²), the cribriform plate was the commonest site (64.7%). Fibrin glue was used in 64.7%, and lumbar drains in 27.1%. Primary success at 3 months was 97.6% (83/85). Complications included nasal crusting (15.3%) and sinusitis (11.8%), with no meningitis, flap necrosis, or neurological deficit. Two patients (2.4%) required secondary repair, achieving 100% overall success; 2-year success was 95.3%, with late recurrence linked to elevated BMI, high-flow leaks, and radiologic IIH.

Conclusion:  This defect-size-based repair protocol achieves excellent primary and overall success rates; long-term surveillance is warranted in IIH or elevated BMI.