An empirical approach to the diagnosis and treatment of cerebrospinal fluid rhinorrhoea: an optimised method for developing countries

Abstract

Background: We aimed to test a new approach for repairing cerebrospinal fluid (CSF) leaks and to determine the demographic, diagnostic, and treatment factors associated with the successful management of intracranial complication. Owing to the high frequency of endoscopic surgeries and the low cost of medical care in Iran, we decided to report our experience of reconstruction after CSF leaks.

Methods: We retrospectively reviewed our experience in the diagnosis and management of CSF rhinorrhoea in Iran between 2005 and 2012. The locations of all pre-repair leaks were identified using simple, readily available methods. The follow-up time ranged from 2 to 72 months.

Results: Of the 37 participants, 59.5% were men and the mean age was 33 years. The success rate was 86.1%, and the most common aetiological factor was trauma (57%). The most common location was the ethmoidal fovea (45.9%), followed by the sphenoid sinus (24.3%), the cribriform plate (13.5%), and the posterior table of the frontal sinus (5.4%).

Conclusion: Medical care in Iran has considerable budget restrictions. This study advocates a practical method of treatment for patients in similar circumstances, with a success rate of 86.1% when compared to the 90.6% achieved with other techniques.

Keywords: cerebrospinal fluid leak, endoscopic, intracranial pressure ICP.

Keywords: cerebrospinal fluid leak; endoscopic; intracranial pressure ICP; skull base defect.

Figure 1:

Endoscopic examination in the examination room is performed after a squatting manoeuvre.

Figure 2:

Removing the mucosa around the defect with a round knife.

Figure 3:

The graft is in a trapezoid shape with the small side being 10 mm shorter than the larger edge, and the larger edge being 10 mm longer than the diameter of the defect.