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
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