Results of Conservative Management of CSF Rhinorrhea in Post Traumatic Patients
DOI:
https://doi.org/10.36552/pjns.v26i2.689Abstract
Objectives: We aimed to see the results of conservative management of CSF rhinorrhea in post-traumatic patients.
Material and Methods: An observational study was conducted on 50 patients for 3 months from 1st November 2021 to 31th Jan 2022. Patients presented to neurosurgery unit II, PINS. All patients had a history of road traffic accidents (RTA).
Results: The age range was 10 – 50 years. The mean age was 25 years. All patients were managed conservatively for one week. We advised complete bed rest to all patients for 2 weeks. Head ends of all patients were slightly inclined from 15 – 30 degrees to reduce pressure in basal cisterns. We gave acetazolamide, mannitol, antibiotics, and anti-epileptic medication to all patients. CSF rhinorrhea in our 43 (86%) patients was stopped completely. In our 5 (10%) patients, CSF rhinorrhea was cured completely after doing a lumbar puncture with drainage of CSF and with the placement of a lumbar drain at a rate of 10 ml per hour. In our 2 (4%) patients, CSF rhinorrhea was not cured. We have to do surgery either by trans cranial or endoscopic repair of CSF rhinorrhea.
Conclusion: CSF rhinorrhea is best cured by conservative management except in 4% of cases.
References
Friedman JA, Ebersold MJ, Quast LM. Post-traumatic cerebrospinal fluid leakage. World J Surg. 2001; 25: 1062-6.
Yilmazlar S, Arslan E, Kocaeli H, Dogan S, Aksoy K, Korfali E et al. Cerebrospinal fluid leakage complicating skull base fractures: analysis of 81 cases. Neurosurg Rev. 2006; 29: 64-71.
Fain J, Chabannes J, Peri G, Jourde J. Frontobasal injuries and CSF fistulas. Attempt at an anatomoclinical classification. Therapeutic incidence. Neurochirurgie. 1975; 21: 493-506.
Iffenecker C, Benoudiba F, Parker F, Fuerxer F, David P, Tadie M et al. The place of MRI in the study of cerebrospinal fluid fistulas. J Radiol. 1999; 80: 37-43.
Lund VJ, Savy L, Lloyd G, Howard D. Optimum imaging and diagnosis of cerebrospinal fluid rhinorrhoea. J Laryngol Otol. 2000; 114: 988-92.
Fu Y, Komiyama M, Nagata Y, Tamura K, Yagura H, Yasui T et al. MR findings in traumatic cerebrospinal fluid leakage with special reference to indications of the need for dural repair. No Shinkei Geka. 1993; 21: 319-23.
Stone JA, Castillo M, Neelon B, Mukherji SK. Evaluation of CSF leaks: high-resolution CT compared with contrast-enhanced CT and radionuclide cisternography. AJNR Am J Neuroradio. 1999; 20: 706-12.
Jones ME, Reino T, Gnoy A, Guillory S, Wackym P, Lawson W. Identification of intranasal cerebrospinal fluid leaks by topical application with fluorescein dye. Am J Rhinol. 2000; 14: 93-6.
Reisinger PW, Hochstrasser K. The diagnosis of CSF fistulae on the basis of detection of beta 2-transferrin by polyacrylamide gel electrophoresis and immunoblotting. Clin Chem Clin Biochem. 1989; 27: 169-72.
Reisinger PW, Lempart K, Hochstrasser K. New methods of diagnosing cerebrospinal fluid fistulas using beta 2-transferrin or prealbumin-principles and methodology. Laryngol Rhinol Otol. 1987; 66: 255-9.
Chan DT, Poon WS, IP CP, Chiu PW, Goh KY. How useful is glucose detection in diagnosing cerebrospinal fluid leak? The rational use of CT and Beta-2 transferrin assay in detection of cerebrospinal fluid fistula. Asian J Surg. 2004; 27: 39-42.
Skedros DG, Cass SP, Hirsch BE, Kelly RH. Sources of error in use of beta-2 transferrin analysis for diagnosing perilymphatic and cerebral spinal fluid leaks. Otolaryngol Head Neck Surg. 1993; 109: 861–4.
Philips BJ, Meguer JX, Redman J, Baker EH. Factors determining E400 Med Oral Patol Oral Cir Bucal, 2007; 12: E397-400. Cerebrospinal fluid rhinorrhoea the appearance of glucose in upper and lower respiratory tract secretions. Intensive Care Med. 2003; 29: 2204-10.
Bell RB, Dierks EJ, Homer L, Potter BE. Management of cerebrospinal fluid leak associated with craniomaxillofacial trauma. J Oral Maxillofac Surg. 2004; 62: 676-84.
Choi D, Spann R. Traumatic cerebrospinal fluid leakage: risk factors and the use of prophylactic antibiotics. Br J Neurosurg.1996; 10: 571-5.
Brodie HA. Prophylactic antibiotics for posttraumatic cerebrospinal fluid fistulae. A meta-analysis. Arch Otolaryngol Head Neck Surg. 1997; 123: 749-52.
Jones NS, Becker DG. Advances in the management of CSF leaks. BMJ. 2001; 322: 122-3.
Brodie HA, Thompson TC. Management of complications from 820 temporal bone fractures. Am J Otol. 1997; 18: 188-97.
Bernal-Sprekelsen M, Alobid I, Mullol J, Trobat F, Tomas-Barberan M. Closure of cerebrospinal fluid leaks prevents ascending bacterial meningitis. Rhinology, 2005; 43: 277-81.
Anand VK, Murali RK, Glasgold MJ. Surgical decisions in the management of cerebrospinal fluid rhinorrhoea. Rhinology, 1995; 33: 212-8.
Ratilal BO, Costa J, Pappamikail L, Sampaio C. Antibiotic prophylaxis for preventing meningitis in patients with basilar skull fractures. Cochrane Database Syst Rev. 2015 Apr. 28. 4: CD004884.
DeConde AS, Suh JD, Ramakrishnan VR. Treatment of cerebrospinal fluid rhinorrhea. Curr Opin Otolaryngol Head Neck Surg. 2015; 23 (1): 59-64
Downloads
Published
Issue
Section
License
Copyright (c) 2022 Rana Zubair Mahmood, Mukhtiyar Ahmed Lakho, Talha Abbas, Abdul Wajid, Touqeer Ahmed, Umer Farooq, Sarfraz KhattakThe 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).