Transnasal endoscopic repair of cerebrospinal fluid rhinorrhea

Abstract

To present the surgical technique and clinical effect of transnasal endoscopic repair of cerebrospinal fluid (CSF) rhinorrhea. From 1996 to 2010, 54 patients with CSF rhinorrhea were treated with intranasal endoscopic surgery, including 25 patients with traumatic CSF rhinorrhea, 17 patients with spontaneous CSF rhinorrhea, and 12 patients with iatrogenic CSF rhinorrhea. The temporalis muscle, temporalis fascial, middle turbinate mucosa, nasal septum mucosa, inferior turbinate mucosa, fascia lata, leg muscle, abdominal fat, uncinate process mucosa and sinus mucosa were used to repair the fistulae. Forty-nine patients were successfully treated after the first operation, 1 after the second attempt, 1 after the third attempt, and 1 was successfully treated at the second operation in other hospital, 1 stopped therapy after an unsuccessful repairing. One patient recurred within one and a half years after operation and stopped therapy. Seven patients developed complications after the operation (high fever in 4, high fever and transient mild coma in 1, epilepsy in 1, pneumocephalus in 1) and were cured afterwards. Transnasal endoscopic surgery is safe, effective and microinvasive treatment for patients with CSF rhinorrhea, it is the first choice for repairing of CSF rhinorrhea for its high successful rate. Accurate leakage site identification, selection of suitable approach and repairing method are critical to the success of operation.