Image-guided endoscopic repair of cerebrospinal fluid rhinorrhea by the bath plug grafting technique

Abstract

Several techniques of endoscopic repair of cerebrospinal fluid (CSF) rhinorrhea were prescribed. Defect localization was mandatory for all. Prospective study. A prospective study was conducted on nonaccidental CSF rhinorrhea. The sensitivity and specificity of image-guided navigation in localizing the defect were studied. The feasibility and reliability of the bath plug technique in repairing the defect were assessed. Six cases were included. CFS rhinorrhea was spontaneous in four and iatrogenic in two. Two defects were in the fovea ethmoidalis, two in the cribriform plate, and two in the sphenoid. The repairing graft was successfully positioned in five cases. In one case a sphenoid obliteration was done. Image-guided navigation proved useful in localizing the defect with a sensitivity and specificity of 100%. All patients were available for follow-up (mean = 19 months). The overall success rate was 83%, and the mean number of surgeries per patient was one. The bath plug was feasible for repairing the anterior skull base defects but not for all the sphenoid defects. It proved reliable as a single management in cases with normal intracranial pressure. The image-guided navigation overrides, in sensitivity and specificity, other methods of localization of the anterior skull base defects.