Endoscopic transnasal repair of CSF rhinorrhea: Techniques and out come

Forhad Hossain Chowdhury,Khandkar Ali Kawsar,Mainul Haque Sarkar,Md Rasiul Haque,Md Shafiqul Islam

doi:10.3329/bjo.v17i1.7618

Forhad Hossain Chowdhury, Khandkar Ali Kawsar + Show 3 more

Open Access

https://doi.org/10.3329/bjo.v17i1.7618

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Abstract

Background: Endoscopic transnasal repair of CSF (Cerebro Spinal Fluid) fistula is safe, effective and widely accepted minimally invasive procedure. We describe our experience of techniques and result of endonasal CSF fistula repair along with its safety and effectiveness as well as low complications. Method: All patients who underwent endonasal CSF fistula repair from July ’07 to September ’09 in the department of Neurosurgery, Dhaka Medical College Hospital & Islami Bank Central Hospital, Dhaka, Bangladesh were prospectively analyzed. Patients were followed up for average period of 10.2 months (Range: 3 to 30 months). Results: The age range was 12 years to 55 years; male -female ratio was 5:8. Clinical features were single nose rhinorrhea, double nose rhinorrhea, anosmia, history of trauma, history of transsphenoidal pituitary surgery, recurrent meningitis, aspiration pneumonia and insomnia, obesity and skeletal dysplasia. Etiology of CSF Fistula were idiopathic-06, congenital hydrocephalus-01, post head injury (traumatic)-05 and post surgical-01case. Anatomical sites of fistula that we found in our series were cribriform plate-06, posterior ethmoidal-04, planum sphenoidalae-02 and sellar-01. Post operatively, 2 patients complained of foul smelling within nose and 1 case had persistent CSF rhinorrhoea, where we over looked a frontal sinus fistula and was closed transcranially later on. There was partial nasal obstruction in 01 case that resolved after a year. New anosmia developed in 01 case after operation. Mortality was nil. Out of 13 transnasal endoscopic repair of CSF fistula 12 cured and 01 persisted (that was retreated by transcranial approach) Conclusion: Endoscopic transnasal CSF fistula repair is associated high success rate of fistula closure along with very few complications; at the same time it is minimally invasive, less traumatic and patient-friendly. So it is our notion that it should be the preferred approach to CSF fistula due to defect in anterior skull base and sellar floor. Key Words: Endoscopic Transnasal; CSF fistula; CSF rhinorrhea. DOI: 10.3329/bjo.v17i1.7618 Bangladesh J Otorhinolaryngol 2011; 17(1): 14-20

Highlights

CSF (Cerebro Spinal Fluid) rhinorrhea and otorrhoea occurs after breakdown of all the barriers that separate the CSF from the nose, paranasal sinuses and the middle air[1]
Anatomical sites of fistula that we found in our series were cribriform plate-06, posterior ethmoidal-04, planum sphenoidalae-02 and sellar-01
Out of 13 transnasal endoscopic repair of CSF fistula 12 cured and 01 persisted

Summary

Introduction

CSF (Cerebro Spinal Fluid) rhinorrhea and otorrhoea occurs after breakdown of all the barriers that separate the CSF from the nose, paranasal sinuses and the middle air[1]. Ommaya[2] classified CSF rhinorrhea as idiopathic, congenital (meningocele, meningoencephalocele, skull base defect, congenital hydrocephalus), postsurgical (paranasal sinus surgery, skull base surgery), non surgical traumatic (Closed head injuries, open or penetrating injuries, post traumatic hydrocephalus) and secondary due to inflammatory, infective or neoplastic lesions invading the skull base Often conservative measures, such as bed rest, rising of head, avoiding strenuous activities, drug treatment or lumbar subarachnoid drain may lead to improvement in CSF rhinorrhea.[3] Surgical treatment is indicated when a CSF fistula do not respond to this procedures, when a CSF leak is identified during endonasal surgery and infective meningitis is found to be secondary to a fistula.[1] In this article, we describe our experience of techniques and result of endonasal CSF fistula repair along with its safety and effectiveness as well as we want to bring to light its less complications. We describe our experience of techniques and result of endonasal CSF fistula repair along with its safety and effectiveness as well as low complications

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Conclusion