TRANSCRANIAL DURAL REPAIR;

Abstract

Objectives: To determine efficacy of transcranial dural repair in managementof early traumatic cerebrospinal fluid (CSF) rhinorrhea by measuring the rate of resolution ofrhinorrhea following repair. Material and Study Design: Descriptive study. Period: 18 monthsfrom March 2014 to September 2015. Setting: Department of Neurosurgery Naseer Teachinghospital Peshawar. Methods: 30 patients, all head injury patients with CSF rhinorrhea of eithergender and any age, reporting to Accident and emergency department were included in thestudy. MRI Brain T2 Weighted in prone position done in all cases to identify the dural rent.Transcranial intradural repair was done through subfrontal approach. Post op complicationswere documented and follow at two months. Results: In this study 30 patients with cerebrospinalfluid (CSF) leak were observed. The minimum age was 8 years and the maximum was 59 years.23 (76.6%) were male and 7 (23.3%) were female. 18 (60%) patients have CSF rhinorrhea dueto road traffic accident, 7 (23.3%) patient with history of fall, while 5 (6.6%) patient were in othercategory. MRI brain T-2 Weighted done in all patient to identify the dural defect. The surgicalapproach was intradural in all of the 30 (100%) patients having fascia lata graft in 28 (93.3%)patients and pericranium in 2 (7%) patients to cover the defect properly. Among the immediatecomplications 3 (10%) patients had recurrent CSF leak, 2(6.6%) had meningitis, 5 (16.6%)had Pneumoencephalus while 3(10%) patients had other complications like subarachnoidhemorrhage, wound infection etc. The overall success rate was 90%. Conclusion: It isconcluded that in post traumatic cerebrospinal fluid (CSF) rhinorrhea, if the defect in dura isdemonstrated it must be repaired as soon as possible in order to prevent fulminant meningitis.