Clinical observation of endoscopic surgery for traumatic cerebrospinal fluid rhinorrhea with nasal autologous tissue

Abstract

Objective To explore the effect and safety of endoscopic surgery for traumatic cerebrospinal fluid rhinorrhea with nasal autologous tissue. Methods Ten cases of traumatic cerebrospinal fluid rhinorrhea patients with endoscopic surgery for traumatic cerebrospinal fluid rhinorrhea with nasal autologous tissue was retrospectively analyzed. There were 7 males and 3 females, aged 23-52 (average 41.6±12.5) years old. The defect site was located in the anterior wall of the ethmoid sinus (4 cases), the sieve plate( 3 cases), the frontal sinus apex(1 case), sphenoid sinus(1 case), and frontal crypt(1 case). There were 6 patients with a skull base defect less than 10 mm and 4 patients with 10-20 mm.According to the size of skull base defect and the degree of cerebrospinal fluid rhinorrhea , nasal endoscopic reconstruction of nasal skull base defect with intranasal autologous tissue was performed. Six cases were resection and repaired with button-typed nasoseptal mucosal-cartilage flap. Four cases were resection and repaired with concha nasalis media flap. Neurologic examination and cerebrospinal fluid biochemical examination were performed after operation. To observe the recurrence of cerebrospinal fluid. Results The operation time of 10 patients was 1-2.5 h, with the 20-50 mL intraoperative bleeding loss, and the hospital stay was 7-14 d. After operation, the patient's vital signs were stable, the pathological signs of the nervous system were negative, and the cerebrospinal fluid biochemical examination was less than 1.7 mmol/L.The headache symptoms before the operation disappeared. Before the discharge, there were no repair material necrosis or shedding in the endoscopic examination area. There was no recurrence of cerebrospinal fluid rhinorrhea after 6 months of follow-up after discharge. Conclusions It's safe and feasible to reconstruct the defect of nasal skull base with autogenous tissue under nasal endoscope for the treatment of cerebrospinal fluid rhinorrhea.This surgery has several advantages of convenience for taking tissue, less trauma, high success rate and low recurrence rate. It is worthy of clinical application . Key words: Cerebrospinal fluid rhinorrhea; Nasal endoscopic surgery; Nasoseptal mucosal-cartilage flap; Reconstruction of skull base