Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2016 Jan;28(84):39-43.

Endoscopic Repair of CSF Rhinorrhea: An Institutional Experience

Sarita Kumari Mishra  1 , George Ani Mathew  2 , Roshna Rose Paul  2 , Syed Kamran Asif  2 , Mary John  2 , Ajoy Mathew Varghese  2 , Mary Kurien  2
Affiliations

Endoscopic Repair of CSF Rhinorrhea: An Institutional Experience

Sarita Kumari Mishra et al. Iran J Otorhinolaryngol. 2016 Jan.

Abstract

Introduction: Endoscopic repair is considered the treatment of choice in cerebrospinal fluid (CSF) rhinorrhea. The aim of our study was to analyze the etiopathogenesis of CSF rhinorrhea, the outcome of treatment and the causes of failure in a developing-country setting.

Materials and methods: A retrospective review of patients treated with endoscopic repair for CSF rhinorrhea at a tertiary care hospital in southern India from January 2002 to December 2009 identified 36 patients, the majority of them being women. The defects were closed in three layers using fat, fascia lata and nasal mucosa along with a fibrin sealant in the majority of the patients. Per-operatively, a subarachnoid drain was placed in all patients. Patients were followed up for 1 year.

Results: Spontaneous onset of CSF rhinorrhea was noted in 61% of patients. The most common site of leak was found to be the left cribriform plate area. Hence the most common cause of CSF rhinorrhea in our study was spontaneous and the second most common was post-traumatic. Our success rate on the first attempt at endoscopic repair was 100%, with a recurrence rate of 6%. A large defect, failure of localization of the defect, or other co-morbid conditions such as chronic cough may be the most likely causes of recurrence of leak.

Conclusion: Accurate localization of the site of lesion using a high-resolution computed tomography (CT) scan with magnetic resonance imaging (MRI) and confirmation of the site of leak by intraoperative Valsalva maneuver along with multilayered closure of the dural defect and post-operative lumbar drain appear to be essential for the successful endoscopic repair of CSF rhinorrhea.

Keywords: CSF rhinorrhea; Cribriform plate; Subarachnoid Space; Transnasal Endoscopic Surgery; Valsalva Maneuver.

PubMed Disclaimer

Figures

Fig1
Fig1
Defect in fovea ethmoidalis area
Fig 2
Fig 2
Endoscopic view of the dural defect
See this image and copyright information in PMC

Similar articles

See all similar articles

Cited by

See all "Cited by" articles

References

    1. Park J-I, Strelzow W, Friedman WH. Current management of cerebrospinal fluid rhinorrhoea. Laryngoscope. 1983;93:1294–300. - PubMed
    1. Presutti L, Mattioli F, Villari D, Marchioni D, Alicandri-Ciufelli M. Transnasal endoscopic treatment of cerebrospinal fluid leak: 17 years’ experience. ActaOtorhinolaryngol Ital. 2009;29(4):191–6. - PMC - PubMed
    1. Banks CA, Palmer JN, Chiu AG, O'Malley BW Jr, Woodworth BA, Kennedy DW. Endoscopic closure of CSF rhinorrhea: 193 cases over 21 years. Otolaryngol Head Neck Surg. 2009;140(6):826–33. - PubMed
    1. Eljamel MS, Foy PM. Non-traumatic CSF fistulae: Clinical history and management. Br J Neurosurg. 1991;5:275–9. - PubMed
    1. Lund VJ, Savy L, Lloyd G, Howard D. Optimum imaging and diagnosis of cerebrospinal fluid rhinorrhea. J Laryngol Otol. 2000;114:988–92. - PubMed

LinkOut - more resources