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. 2017 Jul-Aug;83(4):388-393.
doi: 10.1016/j.bjorl.2016.04.024. Epub 2016 Jun 4.

Endoscopic repair of cerebrospinal fluid rhinorrhea

Vladimir Kljajić  1 , Petar Vuleković  2 , Ljiljana Vlaški  1 , Slobodan Savović  1 , Danijela Dragičević  3 , Vladimir Papić  2
Affiliations

Endoscopic repair of cerebrospinal fluid rhinorrhea

Vladimir Kljajić et al. Braz J Otorhinolaryngol. 2017 Jul-Aug.

Abstract
in English, Portuguese

Introduction: Nasal liquorrhea indicates a cerebrospinal fluid fistula, an open communication between the intracranial cerebrospinal fluid and the nasal cavity. It can be traumatic and spontaneous.

Objective: The aim of this study was to assess the outcome of endoscopic repair of cerebrospinal fluid fistula using fluorescein.

Methods: This retrospective study included 30 patients of both sexes, with a mean age of 48.7 years, treated in the period from 2007 to 2015. All patients underwent lumbar administration of 5% sodium fluorescein solution preoperatively. Fistula was closed using three-layer graft and fibrin glue.

Results: Cerebrospinal fluid fistulas were commonly located in the ethmoid (37%) and sphenoid sinus (33%). Most patients presented with traumatic cerebrospinal fluid fistulas (2/3 of patients). The reported success rate for the first repair attempt was 97%. Complications occurred in three patients: one patient presented with acute hydrocephalus, one with reversible encephalopathy syndrome on the fifth postoperative day with bilateral loss of vision, and one patient was diagnosed with hydrocephalus two years after the repair of cerebrospinal fluid fistula.

Conclusion: Endoscopic diagnosis and repair of cerebrospinal fluid fistulas using fluorescein intrathecally has high success rate and low complication rate.

Introdução: A liquorreia nasal indica uma fístula liquórica, uma comunicação aberta entre o líquido cerebrospinal intracraniano e a cavidade nasal. Pode ser traumática e espontânea.

Objetivo: O objetivo deste estudo foi avaliar o desfecho do reparo endoscópico da fístula liquórica nasal utilizando fluoresceína.

Método: Este estudo retrospectivo incluiu 30 pacientes de ambos os sexos, com idade média de 48,7 anos, tratados de 2007 a 2015. Todos os pacientes foram submetidos à administração lombar de solução de fluoresceína de sódio a 5% no pré-operatório. A fístula foi fechada com enxerto de três camadas e cola de fibrina.

Resultados: As fístulas de líquido cerebrospinal foram comumente localizadas no seio etmoidal (37%) e esfenoidal (33%). A maioria dos pacientes apresentou fístulas liquóricas traumáticas (2/3 dos pacientes). A taxa de sucesso relatada para a primeira tentativa de reparo foi de 97%. Complicações ocorreram em três pacientes: um apresentou hidrocefalia aguda; um, síndrome reversível de encefalopatia no quinto dia de pós-operatório com perda bilateral da visão, e um foi diagnosticado com hidrocefalia dois anos após o reparo de fístula liquórica.

Conclusão: o diagnóstico endoscópico e o reparo de fístulas liquóricas nasais com uso de fluoresceína intratecal tem alta taxa de sucesso e baixo índice de complicações.

Keywords: Cerebrospinal fluid rhinorrhea; Desfecho do tratamento; Endoscopia; Endoscopy; Fistula; Fluorescein; Fluoresceína; Fístula; Nasal surgical procedures; Procedimentos cirúrgicos nasais; Rinorreia de líquido cerebrospinal; Treatment outcome.

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Figures

Figure 1
Figure 1
Fluorescein-stained cerebrospinal fluid fistula with a CSF leak, without using a blue light filter.
Figure 2
Figure 2
Fluorescein-stained cerebrospinal fluid fistula with a CSF leak, with a blue light filter.
Figure 3
Figure 3
The site of defect after repair of CSF leakage.
Figure 4
Figure 4
Distribution of etiologic factors of nasal liquorrhea.
Figure 5
Figure 5
CSF leak fistula locations.
See this image and copyright information in PMC

References

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