Transnasal Endoscopic Repair of Cerebrospinal Fluid Rhinorrhea

Abstract

BACKGROUND: Transnasal endoscopy has recently become a popular method for repair-ing cerebrospinal fluid (CSF) rhinorrhea. It has the advantage of lower morbidity and a high success rate as compared with traditional methods. METHODS: Since April 1997. CSF rhinorrhea has been tried to be repaired by using a transnasal endoscopic approach in our department. Under the endoscope, the dural defect was identified and repaired with a free graft. The free graft was secured with fibrin glue. The graft was further packed with Gelform® and a piece of Merocel® After surgery, anti-biotics were administered to prevent complications. However, a lumbar spinal drain was not used perioperatively. RESULTS: Eleven patients with CSF rhinorrhea have undergone transnasal endoscopic repair. The causes of CSF rhinorrhea was surgical trauma (functional endoscopic sinus surgery) in 9 patients and head injury in another 2 patients. The dural defects were located on the anterior ethmoid roof in 4 patients, on the posterior ethmoid roof in 4 patients, and on the cribriform plate in 3 patients. One patient needed the procedure twice because the first on failed. In total, 12 procedures have been performed. Among them, nine procedures were immediate and 3 were delayed repair. The free graft was harvested from the middle turbinate in 8 procedures, from the inferior turbinate in 2 procedures, from the nasal septum in 1 procedure, and from the ethmoid sinus mucosa in 2 procedures, from the nasal septum in 1 procedure, and from the ethmoid sinus mucosa in 1 procedure. A postoperative complication (meningitis) occurred in 1 procedure. After a mean follow-up of 18.9 months, CSF rhinorrhea was successfully stopped in all patients. CONCLUSIONS: A transnasal endoscopic approach is an effective procedure with lower morbidiy for repair of CSF rhinorrhea from ethmoid sinus and cribriform plate regions after a mean follow-up of 18.9 months.