Factors That Predict Recurrence Following Endoscopic Repair of Cerebrospinal Fluid Rhinorrhea

Abstract

BackgroundThe endoscopic approach has gained popularity in CSF rhinorrhea repair with high success rates, yet recurrence is frequent. In this report, we analyze our cases to determine the outcomes of endoscopic repair of CSF rhinorrhea and the effect of several perioperative factors on the success of repair. MethodsA retrospective review of 50 patients who underwent endoscopic repair of CSF rhinorrhea between January 2013 and July 2023 was performed, collecting details of presentation, surgery, and postoperative period. ResultsThe most frequent etiology was non-traumatic CSF rhinorrhea (76%) wherein the defect was most commonly located at the left cribriform plate, followed by traumatic CSF rhinorrhea (24%) wherein sphenoid defects were most frequent. Traumatic CSF rhinorrhea was more common among males and was significantly associated with anosmia. Success rate at first attempt of repair was 84%. Three patients (6%) had persistent CSF rhinorrhea, and 5 patients (10%) developed recurrence of CSF rhinorrhea. Overall, 7 patients required resurgery, with success rate after 2nd surgery of 100%. The use of 3-layered repair with fat, fascia lata and mucosal flap was protective against failure of repair, whereas bilateral defects and duration of complaints greater than 1 year were significantly associated with failure of repair. The use of lumbar drain did not demonstrate a difference in success rate of repair. ConclusionEndoscopic repair of CSF rhinorrhea appears to be safe and effective when performed with accurate localization of the site of the lesion and multi-layered repair. Potential predictors of recurrence include bilateral and long-standing defects.