Cases Of Cerebrospinal Fluid Rhinorrhea Research Articles

Supraorbital Approaches for Anterior Skull Base and Parasellar Lesions: Insights From a Single-Center Experience.

Modern neurosurgery has undergone significant evolution to include minimally invasive procedures, with the supraorbital approach (SOA) being a prime example. In this study, we aim to explore the surgical techniques and outcomes of this approach in the surgical treatment of frontal lobe, anterior skull base, and parasellar lesions. This study included 33 patients aged 36-83 years who underwent surgery using the SOA for lesions in the inferior frontal lobe, anterior skull base, and parasellar area between 2015 and 2024. There were 25 cases of meningioma, 2 cases of brain abscess, 2 cases of glioma, and one case each of craniopharyngioma, hemangioma, metastasis, and Rathke's cleft cyst. The medical data and follow-up results were retrospectively analyzed. The mean size of lesion was 3.38±3.05 cm. The mean follow-up period was 48.8 months. Gross total resection was achieved in 25 patients (75.8%). There were no perioperative deaths, cases of cerebrospinal fluid rhinorrhea, or infections. Two cases of morbidity were reported as complications: one case of delayed intracerebral hemorrhage and one case of infarction due to vascular injury. All patients exhibited satisfactory cosmetic results. In comparison to the conventional pterional approach, the SOA represents a safe and effective keyhole method for the removal of both extra-axial and intra-axial skull base tumors. This is particularly beneficial for lesions in the orbitofrontal region and parasellar area, as it allows for minimal disruption of normal brain parenchyma. Moreover, the SOA promotes a swift recovery and short hospital stay. Additionally, the SOA yields superior cosmetic results, including the prevention of temporalis muscle atrophy.

Clinical application of transcranial neuroendoscopy combined with supraorbital keyhole approach in minimally invasive surgery of the anterior skull base

To explore the techniques, safety, and feasibility of minimally invasive neurosurgery through the supraorbital eyebrow arch keyhole approach by neuroendoscopy. Retrospective analysis of clinical data of patients with various cranial diseases treated by transcranial neuroendoscopic supraorbital eyebrow keyhole approach in our hospital from March 2021 to October 2023. A total of 39 complete cases were collected, including 21 cases of intracranial aneurysms, 9 cases of intracranial space occupying lesions, 5 cases of brain trauma, 3 cases of cerebrospinal fluid rhinorrhea, and 1 case of cerebral hemorrhage. All patients’ surgeries were successful. The good prognosis rate of intracranial aneurysms was 17/21 (81%), and the symptom improvement rate of intracranial space occupying lesions was 8/9 (88.9%). Among them, the initial symptoms of one patient with no improvement were not related to space occupying, while the total effective rate of the other three types of patients was 9/9 (100%). The average length of the craniotomy bone window of the supraorbital eyebrow arch keyhole is 3.77 ± 0.31 cm, and the average width is 2.53 ± 0.23 cm. The average postoperative hospital stay was 14.77 ± 6.59 days. The average clearance rate of hematoma by neuroendoscopy is 95.00% ± 1.51%. Our results indicate that endoscopic surgery through the supraorbital eyebrow arch keyhole approach is safe and effective for the treatment of anterior skull base lesions and cerebral hemorrhage. However, this retrospective study is a single center, small sample study, and the good surgical results do not exclude the subjective screening of suitable patients by clinical surgeons, which may have some bias. Although the clinical characteristics such as indications and contraindications of this surgical method still require further prospective and multicenter clinical research validation, our study still provides a new approach and choice for minimally invasive surgical treatment of anterior skull base lesions.

Endoscopic Transsphenoidal Surgery with a Layered Peel Strategy for Cushing’s Disease Treatment: A Case Series

Patients with Cushing’s disease (CD) who underwent endoscopic transsphenoidal surgery (ETS) with a layered peel strategy at our center were retrospectively analyzed. Records on patients’ basic characteristics, preoperative and early postoperative evaluations, perioperative complications, and follow-up were collected. A total of 12 unselected, consecutive patients with CD were identified. Ten of the twelve patients were female. All tumors were confirmed by magnetic resonance imaging, with a maximum tumor diameter ranging from 5 mm to 11 mm. A lower rate of surgical complications was identified postoperatively, with no cases of carotid artery injury, epistaxis, hematoma, visual disturbance, or intracranial infection, but with one case of cerebrospinal fluid rhinorrhea. Ten patients experienced immediate remission, and two had delayed remission. No recurrence events were observed during a median follow-up of 51 months. In conclusion, our preliminary experience indicated that ETS with a layered peel strategy provided a perfect remission rate, low complication rate, and no recurrence in a case series of CD patients. Given the limited number of cases, future studies are warranted to confirm its effectiveness and safety.

Experience and modification of skull base reconstruction results in lower complications rates

To investigate the efficacy of nasal septum bone flap combined with vascularized pedicle nasoseptal flap (VP-NSF) in the treatment of high-flow cerebrospinal fluid (CSF) leakage in the endonasal endoscopic skull base surgery. A total of 156 patients in group A used a multi-layer skull base reconstruction method of fat-absorbable artificial dura mater- fascia lata-VP-NSF, and were treated with drainage of the lumbar cistern after surgery, in addition, a total of 94 patients in group B used a multi-layer skull base reconstruction method of fat-absorbable artificial dura mater-nasal septal bone flap-VP-NSF, and no lumbar cistern drainage was performed after surgery. Analyzed and compared the differences of postoperative cerebrospinal fluid rhinorrhea, intracranial infection, re-repair, average bed rest time, pulmonary infection and deep venous thrombosis of lower extremities were analyzed and compared in the two groups. In group A, 11 cases of cerebrospinal fluid rhinorrhea occurred after operation. In addition, 15 cases developed intracranial infection. During this period, there were 20 cases of pulmonary infection and 3 cases of deep venous thrombosis of lower extremities. In group B, there were 1 case of cerebrospinal fluid rhinorrhea (P < 0.05), 2 cases of intracranial infection (P < 0.05), 2 cases of pulmonary infection (P < 0.05), and 0 case of deep venous thrombosis of lower extremities (P > 0.05). Nasal septum bone flap combined with VP-NSF is effective in the treatment of high-flow CSF leaks in the endonasal endoscopic skull base surgery, which can avoid postoperative lumbar cistern drainage and is worth popularizing.

The application of pedicled middle turbinate mucosal flap in transnasal endoscopic repair of cerebrospinal fluid rhinorrhea

Objective:To investigate the application and efficacy of pedicled middle turbinate mucosal flap in transnasal endoscopic repair of cerebrospinal fluid rhinorrhea. Methods:15 patients with cerebrospinal fluid rhinorrhea were retrospectively analyzed，including 13 patients with simple cerebrospinal fluid rhinorrhea （86.7%） and 2 patients with cerebrospinal fluid rhinorrhea with meningoencephalocele （13.3%）. According to the location of the fistula, the pedicled middle turbinate mucosal flap under nasal endoscopy was used to repair cerebrospinal fluid rhinorrhea, in which 5 cases （33.3%） had leakage at the top of the sieve and 8 cases （53.3%） had leakage at the sieve plate. Two cases had leakage at the lateral racess of sphenoid sinus. Results:All cases of cerebrospinal fluid rhinorrhea were repaired successful and the mucosa epithelialized well in the operative area. There was no recurrence of cerebrospinal fluid rhinorrhea or other complications during the follow-up period of 4-24 months （average 13 months）. Conclusion:The pedicled middle turbinate mucosal flap has a high success rate for repairing cerebrospinal fluid rhinorrhea, and the nasal cavity damage is small, which is worthy of clinical promotion.

ANTERIOR CLINOIDECTOMY IN CLINOID SEGMENT INTERNAL CAROTID ANEURYSMS AND PARACLINOID MENINGIOMA: FROM ANATOMY TO NEUROSURGERY

Objectives: To assess the role of anatomy in the anterior clinoidectomy. Patients and methods: Retrospective study with ten patients who were surgically treated with the anterior clinoidectomy for the paraclinoid lesions at Viet-Duc Hospital from January 2020 to December 2020. Results: Mean age: 42.58 ± 12.49; sixty percents male and forty percents female. There was only one case that had pneumatization of the anterior clinoid process. On diagnosis, there were four cases with internal carotid aneurysms and six cases of paraclinoid meningioma. The extradural anterior clinoidectomy were in seven cases while the intradural way was in three cases. There was only one case of cerebrospinal fluid rhinorrhea as a complication. Conclusion: The anterior cliniodectomy was still challenging in neurosurgery. Understanding the anatomy of the anterior clinoid process was mandatory.

Effect of Fe₃O₄ Nanomaterial-Based MRI on the Efficacy of One-Sided Butterfly Sinus Lesions in the Nose.

Fe₃O₄ materials have many crystal forms, and the morphology of their nanomaterials is more diverse. Under the influence of nano-effects, they exhibit unique physical and chemical properties. The synthesized Fe₃O₄ materials with different morphologies have different properties. They are widely used in related fields such as electromagnetics, chemical engineering, catalysis, sensors, acoustics, medicine, environmental protection and so on. Choosing the appropriate contrast agent to display the anatomical characteristics of diseased and normal tissue is an important thing before using MRI (Magnetic Resonance Imaging) technology. At present, Gd-DTPA is a commonly used magnetic contrast agent in clinical practice, but Gd-DTPA has obvious shortcomings, such as short circulation time, non-specific distribution, and high price. In comparison, the superparamagnetic iron oxide nanocrystals have a high specific distribution in living tissues, mainly concentrated in reticular endothelial cells-rich tissues and organs, such as liver, spleen, lymph nodes and bone marrow. This study analyzed the imaging characteristics of 21 patients with unilateral benign sphenoid sinus disease who were confirmed by nasal endoscopic surgery and postoperative pathology. Among the 21 patients with unilateral benign sphenoid sinus lesions, 7 cases of them had cysts. Those with altered sphenoid sinus cavity expansion may be accompanied by thinning of bone resorption. MRI manifested as long T1 and long T₂ irregular spherical signal shadows. 8 cases of them are fungal lesions. MRI showed mixed signals are in the sphenoid sinus, the flaky exudation showed a high signal, and the fungal nodule showed a low T₂WI signal. In the 3 cases of cerebrospinal fluid rhinorrhea, MRI showed a line between the high-signal shadow of the cerebrospinal fluid and the high-signal liquid shadow in the sinuses. High signal and shadow are connected, and other tissues (brain tissue, nasal mucosa) show low signal. Fe₃O₄-based MRI technology can improve imaging quality and diagnostic efficiency.

Analysis on endoscopic endonasal approach combined with the frontotemporal orbitozygomatic approach under the microscope for skull base tumor with intra and extra-cranial involvement

Objective: To evaluate the application of combination use of endoscopic endonasal approach combined with the frontotemporal orbitozygomatic approach microscopically in skull base tumor with intra and extra-cranial involvement. Methods: A total of 7 patients (4 males and 3 females, aging from 27 to 65 years old, with a medium age of 48) undergone complicated skull base surgeries via endoscopic endonasal approach combined with the frontotemporal orbitozygomatic approach microscopically from May 2016 to January 2018 were reviewed respectively. The patients included 2 cases of recurrent invasive pituitary adenoma, 3 cases of basal skull meningiomas, 1 case of clivus chondrosarcoma, and 1 case of recurrent nasopharyngeal carcinoma. The lesion extensively infiltrated nasal cavity, extending to the paranasal sinus, bilateral cavernous sinus, sellar region, suprasellar, superior clivus, temporal lobe, pterygopalatine fossa, infratemporal fossa and important intracranial vessels. All the 7 patients were treated under general anesthesia by endoscopic endonasal approach combined with frontotemporal orbitozygomatic approach under the microscope. Total excision rate, intraoperative and postoperative complications and postoperative curative effect were observed. All of them were followed up for 6 to 12 months. The Glasgow Outcome Scale (GOS) was used to evaluate the prognosis. Result: Total tumor removal was performed in 5 cases, subtotal removel in 2 cases. There was no complication during the operation. Postoperative severe complications occurred in 2 cases, including 1 case of cerebrospinal fluid rhinorrhea and intracranial infection, which was cured by lumbar cistern drainage and intrathecal injection; 1 case occurred oculomotor nerve paralysis, which recovered during follow-up. Postoperative complications occurred in 1 case of trochlear nerve dysfunction, 2 cases of facial numbness, and 1 case of tinnitus. During follow-up, all patients recovered to varying degrees. There was no bleeding and death after the operation. No tumor recurred during the follow-up period. All patients were recovered well with GOS grade Ⅳ-Ⅴ. Conclusions: Endoscopic transnasal approach combined with microscopic frontotemporal orbitozygomatic approach can remove tumors in one stage, reduce surgical complications and improve surgical effect. It has good application prospects and is suitable for excising complex intracranial and extracranial communicating tumors of widely involving sellar, clivus and petrous apex area.

A Case of Cerebrospinal Fluid Rhinorrhea Associated with Meningocele Treated with Endoscopic Endonasal Approach

A Case of Cerebrospinal Fluid Rhinorrhea Associated with Meningocele Treated with Endoscopic Endonasal Approach

Successful Treatment of Spontaneous Cerebrospinal Fluid Rhinorrhea With Endoscopic Third Ventriculostomy and Lumboperitoneal Shunt: A Case Report.

Spontaneous cerebrospinal fluid (CSF) rhinorrhea represents an important clinical entity that is being observed with increasing prevalence, ranging from 14 to 55%. Spontaneous CSF rhinorrhea is associated with elevated intracranial pressure (ICP), which is rarely stopped without surgical intervention. Endoscopic endonasal repair is typically warranted for CSF rhinorrhea. However, the recurrence rate of CSF leaks after the endoscopic endonasal repair of skull base defects due to ICP is usually high. We describe a 25-year-old man without a history of head injury, tumor, or obesity. The onset of his symptoms occurred in 1 week in the form of a persistent clear left nostril rhinorrhea. Computed tomography (CT) and magnetic resonance images (MRI) showed signs of CSF in the left sphenoidal sinus, meningocele in the left frontal sinus, empty sella, hydrocephalus, and Chiari I malformation (CIM). Cine-MRI revealed the flow of CSF was obstructed at the aqueduct and the outlet of the fourth ventricle. Endoscopic third ventriculostomy (ETV) was performed for the patient with obstructive hydrocephalus. Post-operative CSF pressure measurement demonstrated elevated ICP. The patient still had case of CSF rhinorrhea, and subsequently underwent lumboperitoneal shunt (LPS) for treatment of ICP. The patient showed a prompt resolution of CSF leak. Ten months later, the patient showed a significant improvement in terms of his herniated tonsil and cessation of CSF rhinorrhea.

DRIP DROP FROM THE NOSE, IT IS NOT RHINITIS, IT WILL NOT STOP

Introduction Cerebrospinal fluid (CSF) rhinorrhea occurs due to an abnormal communication between the subarachnoid space and the nasal cavity. Spontaneous CSF (sCSF) leaks are those not explained by traumatic injury, previous surgery, or secondary causes. We present a case of sCSF leak misdiagnosed as allergic rhinitis. Case Description A 64-year-old Hispanic woman with past medical history of hypertension, renal cell carcinoma, hypothyroidism and no prior surgery presented with a one-year history of continuous clear rhinorrhea from her left nostril. The patient had persistent cough and postnasal drip despite multiple courses of antibiotics, intranasal steroids, and oral antihistamines. Rhinoscopy and CT of the temporal bones were negative, but sample of the nasal fluid tested positive for beta-2 transferrin. A brain MRI revealed bilateral cribriform meningocele as a most likely site of CSF leak (Figure 1). There were also meningoceles of Meckel cave and jugular foramina along with increased optic nerve sheath diameter suggesting elevated intracranial pressure. Endoscopic sinus surgery with intrathecal fluorescein showed an active CSF leak on the left side and meningocele on the right. The leak was repaired with a nasal septal flap. On clinical follow-up 3 months after surgery, the patient reported no rhinorrhea or post-nasal drip. Discussion sCSF leaks are responsible for 6-23% cases of CSF rhinorrhea. The clinical diagnosis can be challenging because of their resemblance to chronic rhinitis. Failed response to medical management should raise suspicion. sCSF should be repaired to prevent meningitis and intracerebral infection, therefore early identification with β-2 transferrin testing is crucial. Figure. A. Right cribriform meningocele (red arrow), however, the leak can be seen as a linear fluid signal in the nasal roof on the left side from a cribriform plate defect (white arrow). B. Dilated optic nerve sheath diameter (8.4 mm, normal C. Dural diverticula arising from Meckel's cave (arrows)

Binostril endoscopic transsphenoidal neurosurgery for pituitary adenomas: experience with 42 patients.

Here we review the technical aspects of our experience with the neuroendoscopic bilateral nostril (binostril) transsphenoidal approach for pituitary adenomas. A total of 42 patients were treated in our hospital from September 2013 to December 2015. Total tumor resection was completed in 31 cases, nearly full resection was achieved in 9 cases, and partial resection was achieved in 2 cases. In most cases clinical symptoms were relieved after surgery. These included 18/22 cases with visual field and vision disorders; 19/25 cases with headaches; 11/15 cases where high baseline PRL returned to normal levels; 6/7 cases where elevated blood GH returned to normal levels; and 2/3 cases where elevated blood ACTH returned to normal levels after surgery. Postoperative complications were observed in 13 patients: 8 cases of diabetes insipidus, 4 cases of cerebrospinal fluid rhinorrhea, and 1 case of subarachnoid hemorrhage. Among the key advantages of the neuroendoscopic binostril transsphenoidal approach for pituitary adenoma resection are its minimally-invasive nature, clear exposure of the operative field, high full-excision rates, improved peri-operative safety, and minor patient trauma with fewer postoperative complications.

A rare case of cerebrospinal fluid rhinorrhea post external dacryocystorhinostomy surgery

Cerebrospinal fluid (CSF) leakage is an uncommon but significant complication of orbital and rarely lacrimal surgery. We report a rare case of CSF rhinorrhea following external dacryocystorhinostomy (DCR) surgery. A 38-year-old healthy lady was diagnosed to have chronic dacryocystitis for which right side external DCR was done. At the evening of first postoperative day, the patient noticed a discharge of clear fluid coming through the right nostril, in sitting posture. The fluid was sent for biochemical analysis. Based on clinical and biochemical tests of fluid, a diagnosis of iatrogenic CSF rhinorrhea was made. Contrast enhanced computed tomography and computed tomography cisternography failed to reveal any site of active leakage. However, the patient improved with conservative management only. CSF leakage occurs very rarely in external dacryocystorhinostomies with only a few case reports found in the literature. Knowledge of anatomy and thorough preoperative assessment may predict areas at high-risk for encountering this problem.

Congenital CSF Rhinorrhoea sans Encephalocoele, sans Trauma, sans Tumour

The authors describe a case of cerebrospinal fluid rhinorrhea due to a congenital defect in cribriform plate, an anomaly that has not been described hitherto. It was successfully treated surgically.

A Sandwich Technique for Prevention of Cerebrospinal Fluid Rhinorrhea and Reconstruction of the Sellar Floor after Microsurgical Transsphenoidal Pituitary Surgery.

Cerebrospinal fluid (CSF) leaks are a well-known complication of transsphenoidal surgery. Several autologous and artificial grafts have been used to close the sellar floor in an attempt to prevent postoperative CSF rhinorrhea. To evaluate and describe a sandwich technique to close the sellar floor using autologous bone, absorbable gelatin sponge, and coated collagen fleece. We reviewed 50 consecutive patients between April 2010 and August 2011 who underwent transsphenoidal surgery ending with reconstruction of the sellar floor with a particular sandwich technique. Patients with an intraoperative CSF leak received an additional lumbar drain. There were no cases of CSF rhinorrhea at postoperative follow-up after 6 weeks and no revision surgery. The proposed sandwich technique for closure of the sellar floor to the sphenoid sinus is a suitable alternative to autologous grafts and seems to be effective in preventing CSF rhinorrhea.

Direct suture technique of normal gland edge on the incised dura margin to repair the intraoperative cerebrospinal fluid leakage from the arachnoid recess during transsphenoidal pituitary tumor surgery.

During transsphenoidal surgery for pituitary adenomas with large suprasellar extension, cerebrospinal fluid (CSF) leakage commonly develops from a defect at the arachnoid recess between the resected dura margin and the anterior edge of a normal pituitary gland (type 1 CSF leakage). To evaluate the usefulness of a direct suture technique of the normal gland edge on the incised dural margin to repair intraoperative CSF leakage from the arachnoid recess. Between November 2005 and December 2012, 861 patients with pituitary adenomas were operated on with transsphenoidal surgery, and intraoperative CSF leakage was encountered in 432 patients. Type 1 CSF leakage developed in a total of 122 patients, and their defects were repaired with the direct suture technique in 51 patients, whereas a fleece-coated fibrin glue patch alone was applied onto the defect in the other 71 patients. This direct suture technique required an additional 5 to 20 minutes in most cases. We experienced no case of postoperative CSF rhinorrhea in the 51 patients whose defects were repaired by the direct suture technique and only 1 case of CSF rhinorrhea in 71 patients whose defects were repaired with a fleece-coated fibrin glue patch alone. There was no statistical difference in the outcome between 2 groups. Postoperative lumbar CSF drainage was not performed in any case. Our 2 different repair techniques for arachnoid recess tears are very reliable methods for managing this type of CSF leakage. The direct suture technique may be more appropriate for type 1 CSF leakage with a wider gap and more prominent CSF leakage.

A multicentre, prospective, randomized, controlled study to evaluate the use of a fibrin sealant as an adjunct to sutured dural repair

Background. Obtaining intra-operative watertight closure of the dura is considered important in reducing post-operative cerebrospinal fluid (CSF) leak. The purpose of this study was to evaluate a fibrin sealant as an adjunct to sutured dural repair to obtain intra-operative watertight closure in cranial neurosurgery. Methods. This randomized, controlled multicenter study compared a fibrin sealant (EVICEL® Fibrin Sealant [Human]) to sutured dural closure (Control). Subjects underwent supratentorial or posterior fossa procedures. Following primary dural repair by sutures, the closure was evaluated for intra-operative CSF leak by moderately increasing the intracranial pressure. If present, subjects were randomized to EVICEL® or additional sutures (2:1 ratio), stratified by surgical approach. Following treatment, subjects were successful if no CSF leaks were present during provocative challenge. Safety was assessed to 30 days post-surgery, including incidence of CSF leakage. Results. One hundred and thirty-nine subjects were randomized: 89 to EVICEL® and 50 to Control. Intra-operative watertight closure was achieved in 92.1% EVICEL®-treated subjects versus 38.0% controls; a treatment difference of 54.1% (p < 0.001). The treatment differences in the supratentorial and posterior fossa strata were 49.1% and 75.7%, respectively (p < 0.001). The incidence of adverse events was similar between treatment groups. No deaths or unexpected serious adverse drug reactions were reported. CSF leakage within 30 days post-operatively was 2.2% and 2.0% in EVICEL® and control groups, respectively. In addition, 2 cases of CSF rhinorrhoea were observed in the EVICEL® group. Although not associated with the suture line where EVICEL® was applied, when combined with the other CSF leaks, the observed leak rate in the EVICEL® group was 4.5%. Conclusions. These results indicate that EVICEL® is effective as an adjunct to dural sutures to provide watertight closure of the dura mater in cranial surgery. The study confirmed the safety profile of EVICEL®.

Two Cases of Cerebrospinal Fluid Rhinorrhea Caused by Closed Nasal Reduction

Cerebrospinal fluid (CSF) rhinorrhea usually occurs after a traumatic or non-traumatic head injury, as more than 80% of all cases of CSF rhinorrhea are caused by traumatic head injuries. In fact, CSF rhionorrhea is observed in 2 to 3% of traumatic head injuries, with 50% of the CSF found in the anterior cranial fossa, but mostly of them in the cribriform plate. CSF rhionorrhea can occur two days after a traumatic head injury, but it can take up to 3 months to notice the symptoms of CSF rhionorrhea in a patient with a traumatic head injury. Iatrogenic CSF rhionorrhea is usually caused by neurosurgery operation or otorhinolaryngological surgery such as sinus surgery. For example, closed reduction treating nasal bone fractures can cause CSF rhionorrhea, so patients should be watched at all times. This paper reports two cases of CSF rhionorrhea caused by closed nasal reduction.

Cerebrospinal Fluid Rhinorrhea: Causes, Sites, Management and Recurrence

The aim of this study is to report the sites, management and recurrence of rhinorrhea, and to compare our results with those obtained from other centers. The medical records of patients with cerebrospinal fluid rhinorrhea in Otorhinolaryngology, and Head and Neck Surgery Department at King Abdulaziz University Hospital, Jeddah, Saudi Arabia, from January 2003 to May 2011 were retrospectively reviewed. Ten cases of cerebrospinal fluid rhinorrhea were treated during the study period. The most frequent causes were endoscopic sinus surgery (50%), spontaneous (30%) and others (20%). Defects were located at the cerebriform plate (n = 6), left fronto-ethmoidal area (n = 1), at roof of the left frontal sinus (n = 1), at the junction between the cerebriform plate and bulla ethmoidalis (n = 1), and at the roof of the sphenoid sinus (n = 1). Patients were followed up for 6 to 24 months. The initial closure was successful in 6 patients; 5 after endoscopic sinus surgery and 1 after conservative treatment. Overall closure rate was 90.0%; 87.5% after endoscopic sinus surgeries. In conclusion, the most frequent cause of cerebrospinal fluid rhinorrhea was endoscopic sinus surgery and the cerebriform plate was the most common defect location. The overall rate of closure after endoscopic sinus surgery and conservative treatment was high.

The application nasal endoscopy and high resolution CT in the diagnosis and treatment of cerebrospinal fluid rhinorrhea

Objective To evaluate the endoscopic repair of cerebrospinal fluid rhinorrhea accurately and combined therapy after operation. Methods Collected our department endoscopic repair of cerebrospinal fluid rhinorrhea clinical data of 28 patients from 2005 to 2009, with post-traumatic cerebrospinal fluid rhinorrhea in 20 cases, idiopathic in 8 cases of cerebrospinal fluid rhinorrhea. By thin-layer spiral CT and endoscopic mucosal leakage characteristics of the mouth to determine the location of mouth leakage, using thigh fascia lata as a repair material. Results All 28 patients were followed up for more than 3 months, the initial surgery in 27 cases, 1 case was re-surgery. The sites of cerebrospinal fluid is located in the Ethmoid roof wall of 11 cases, 6 cases of cribriform plate, sphenoid sinus in 6 cases, frontal sinus openings in 4 cases, 1 case of Ethmoid and sphenoid sinus. All patients were successfully treated once. Conclusion Thin spiral CT and endoscopic drain mouth pale edema mouth mucosa is essential for determining the leakage. The combined treatment after operation will help ensure a successful surgical repair. Key words: Endoscopic surgery; High-resolution CT; Mucosal edema; Cerebrospinal fluid rhinorrhea