Abstract
Cerebrospinal fluid (CSF) rhinorrhea is potentially serious because it may lead to recurrent meningitis. Therefore, early diagnosis and appropriate treatment of CSF rhinorrhea are required.We treated 13 patients with CSF rhinorrhea during the past 15 years. Four of them had meningitis. All 13 were successfully treated surgically with a rhinological approach in 12 and an intracranial approach in one. On the basis of our experience, RI counts of intranasal pledgets and detection of tau-transf errin in the nasal discharge were helpful in the diagnosis of CSF rhinorrhea. A coronal CT scan was useful in the determination of the precise location of the fistula.For a surgical treatment, a rhinological approach with minimal morbidity was indicated in most patients. Key points of the operation are: 1) careful observation of the fistula under an operating microscope or a rigid nasal endoscope, 2) water-tight closure of the fistula with fibrin glue and two or three layers of autogenous fascia, 3) intra-and postoperative CSF drainage to prevent an increase of intracranial pressure.
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