Nasal Liquorrhea Research Articles

Reasons for failure of surgical treatment of patients with congenital basal encephaloceles

Encephalocele or craniocerebral hernia is a disease in which there is a prolapse of the meninges and structures of the brain through a skull defect. Clinically, they are manifested by a violation of nasal breathing, deformation of the naso‑ethmoid region, and nasal liquorrhea. Various inflammatory complications (meningitis, meningoencephalitis, ventriculitis, brain abscess) can occur against the background of persistent hernia, while mortality is 8–10 %.Basal encephalocele is a rare pathology that requires an integrated approach in a specialized hospital using high‑tech equipment. Therapeutic tactics and risks are determined individually based on the patient’s age, current symptoms, size of the nasal cavity, location and size of the skull base defect. In the absence of nasal liquorrhea, it is possible to delay surgical treatment in order to be able to use an autologous bone of the calvarium, to collect a larger periosteal flap, to perform the operation using a combined approach and to minimize surgical complications. With endonasal endoscopic access, it is necessary to separate the encephalocele from the surrounding tissues, completely remove the hernial sac and visualize the bone edges of the defect, and then perform its plastic closure.Despite the fact that in most cases the existing methods of treatment are very effective, in a number of cases it is not possible to achieve the desired result. This article presents two rare clinical cases in which patients with basal encephalocele required reoperation for herniation and skull base defect repair.

Ликворея как следствие перенесенной новой коронавирусной инфекции COVID-19

The article presents a clinical case of cerebrospinal fluid leak after suffering COVID-19. The clinical picture of the disease was dominated by obvious nasal liquorrhea that occurred without previous injuries. The patient’s condition was stable. Nasal liquorrhea was diagnosed clinically and according to MRI of the head.

Plastic closure of bone defects of anterior cranial fossa floor in surgery of benign and malignant craniofacial tumors

Objective: to analyze the results of using various methods of plastic closure of bone defects of the anterior cranial fossa (ACF) floor when removing craniofacial tumors of the ACF floor depending on the size of the defect. Materials and methods. A retrospective analysis of treatment outcomes of 122 patients with craniofacial tumors of the ACF floor was carried out. According to the nature of the lesions malignant craniofacial tumors were detected in 98 (80.3%) patients, and benign ones in 24 (19.7%) patients. The following neurosurgical approaches to craniofacial tumors of the ACF floor were used: bifrontal - in 58 (47.5%) patients, subcranial - in 49 (40.2%), transbasal Derome - in 8 (6.5%), frontotemporal - in 4 (3.25%), expanded endoscopic - in 3 (2.45%). In 52 (42.6%) cases, endoscopic endonasal assistance was used, most often in the case of plasty of large ACF floor defects to revise the surgical defect, assess the sufficiency of plasty and tamponade of the nasal cavity with balloon catheters. Results. Patients were divided into groups depending on the bone defect of the ACF floor: median - in 27 (22.1%), middle-expanded - in 71 (58.2%), middle-lateral - in 24 (19.7%). The following types of plasty of the bone defect of the ACF floor were used: pedicle flap - 83 (68.0%) cases, free flap - 22 (18.1%), pedicled periosteal flap with reinforcement - 17 (13.9%). Postoperative complications occurred in 17 (13.9%) patients: nasal liquorrhea in 10 (8.2%) patients (of which 6 underwent reoperation to eliminate it), in 7 patients it was complicated by meningoencephalitis, in other 7 (5.7 %) - meningoencephalitis without signs of nasal cerebrospinal fluid. Postoperative mortality was 0.71% (1 patient). The frequency of nasal cerebrospinal fluid in the group of plasty using a free flap was 13.6% (3 cases), meningoencephalitis - 4.5% (1 observation), in the group of plasty using pedicle flap - 4.8% (4 cases) and 6.0% (5 observations), in the group of plasty using a pedicle flap with reinforcement - 17.6% (3 cases) and 11.7% (2 observations). In 33 (27.1%) cases the use of the author's method of bone defect plasty of the ACF floor with duplication of complications were not registered. Conclusions. Significant size and spread of bone defects of the ACF floor increase the risk of postoperative complications. The use of free flaps for plasty of the bone defect of the ACF floor is ineffective and is associated with a high risk of complications. The proposed method of plasty of the posterior parts of the ACF floor by duplication of the periosteal flap promotes the sealing of the posterior parts, where suturing causes certain difficulties. Reinforcement of plasty from the side of the nasal cavity due to endoscopic technique using tamponade or balloon catheters reduces the incidence of postoperative complications.

Differential diagnosis of pneumonia as a complication of nasal liquorrhea in the context of the COVID-19 pandemic: Case report

Nasal liquorrhea the outflow of cerebrospinal fluid from the cerebrospinal fluid spaces of the cranial cavity into the nasal cavity or paranasal sinuses due to the presence of a congenital or acquired defect in the bones of the skull base and meninges of various etiologies. Nasal liquorrhea leads to potentially fatal complications: meningitis, meningoencephalitis, pneumocephalus, brain abscess. Also, with nasal liquorrhea, less dangerous complications may occur: aspiration bronchopneumonia and gastritis. The article presents a case of aspiration pneumonia in two patients with nasal liquorrhea treated at the Burdenko National Medical Research Center for Neurosurgery during the COVID-19 pandemic. Both patients noted the profuse nature of the nasal liquorrhea, complained of coughing in a horizontal position. In both cases, no RNA virus (SARS-CoV-2) was detected during the polymerase chain reaction. Antibodies (IgG, M) to coronavirus were not detected. Computed tomography of the chest organs in both cases revealed areas of frosted glass darkening. Since no data was obtained for coronavirus infection (negative tests for coronavirus, lack of antibodies), changes in the lungs were interpreted as a consequence of constant aspiration of CSF. The patients were admitted to a separate ward. Both patients underwent endoscopic endonasal plasty of the skull base defect. The postoperative period in both cases was uneventful. In both cases, the patients underwent computer tomography scan of the chest organs one month later. On the photographs, the signs of pneumonia completely regressed.

Differential Diagnosis of Pneumonia as a Complication of Nasal Liquorrhea in the Context of the COVID-19 Pandemic

Nasal liquorrhea — the outflow of cerebrospinal fluid from the cerebrospinal fluid spaces of the cranial cavity into the nasal cavity or paranasal sinuses due to the presence of a congenital or acquired defect in the bones of the skull base and meninges of various etiologies. Nasal liquorrhea leads to potentially fatal complications: meningitis, meningoencephalitis, pneumocephalus, brain abscess. Also, with nasal liquorrhea, less dangerous complications may occur: aspiration bronchopneumonia and gastritis. The article presents a case of aspiration pneumonitis in two patients with nasal liquorrhea treated at the N.N. N.N. Burdenko during the COVID-19 pandemic. Both patients noted the profuse nature of the nasal liquorrhea, complained of coughing in a horizontal position. In both cases, no RNA virus (SARS-CoV-2) was detected during the polymerase chain reaction. Antibodies (IgG, IgM) to coronavirus were not detected. Computed tomography of the chest organs in both cases revealed areas of frosted glass darkening. Since no data was obtained for coronavirus infection (negative tests for coronavirus, lack of antibodies), changes in the lungs were interpreted as a consequence of constant aspiration of cerebrospinal fluid. The patients were admitted to a separate ward. Both patients underwent endoscopic endonasal plasty of the skull base defect. The postoperative period in both cases was uneventful. In both cases, the patients underwent computed tomography scan of the chest organs one month later. On the photographs, the signs of pneumontis completely regressed.

Endoscopic transsphenoidal removal of neoplasms of the chiasmal-sellar region in children

The OBJECTIVE was to analyze the results of endoscopic transsphenoidal removal of neoplasms of the chiasmalsellar region in children.MATERIALS AND METHODS. We studied 23 patients aged 3 to 17 years who underwent endoscopic transsphenoidal removal of neoplasms of the chiasmal-sellar region. Neurological, ophthalmological, endocrine disorders and otorhinolaryngological pathology were evaluated. Neuroimaging data (MRI and CT), results of laboratory tests were studied. In addition, the analysis of surgical treatment including intraoperative and early postoperative complications was performed.RESULTS. In 39.1 % of cases, neoplasms of supraparainfracellar localization were diagnosed. In 34.8 % of patients, the size of the neoplasms did not exceed 2 cm. In 1 patient, the volume of neoplasm was 53.7 cm3. According to the type of pneumatization, the sellar type prevailed. Сonch type was observed in 1 child. Hemostatic material «Surgicel Fibrillar» was used more often (86.9 %). Plastic surgery of the skull defect was carried out on a floor-by-floor basis with «Tachocomb» plates (62.5 %). Total tumor removal was achieved in 75 % of children. The majority of neoplasms were represented by craniopharyngioma – 30.43 %. In the early postoperative period, there was a significant regression of neurological disorders – by 69.6 %, as well as ophthalmological – by 34.8 % and endocrine – by 37.8 %. There were no cases of nasal liquorrhea and epistaxis in children.CONCLUSION. Our study demonstrated the success of removing neoplasms in children from 3 years old, regardless of the size of the nasal cavity and pneumatization of the sphenoid sinus. It is possible to use endoscopic transsphenoidal access in children to remove the neoplasms of the chiasmal-sellar region of more than 5 cm, since the risk of intra – and postoperative complications is minimized.

Subcutaneous emphysema and pneumomediastinum after endoscopic transnasal removal of nasopharyngeal angiofibroma

Introduction. Juvenile nasopharyngeal angiofibroma is a rare, benign, well-vascularized tumor of the skull base characterized by destructive growth. The development of endoscopic techniques and experience of surgeons have enabled the removal of this tumor both at early stages and late stages (advanced disease). Patients may develop various complications in the intraoperative and postoperative periods, including massive bleeding, nasal liquorrhea, facial paresthesia, lacrimal hyposecretion, etc. Air penetration into the subcutaneous fat and mediastinum during endoscopic surgery on the paranasal sinuses is rare. Such complication as subcutaneous emphysema and pneumomediastinum after endoscopic endonasal removal of juvenile nasopharyngeal angiofibroma has not been reported in the literature.Case report. A 19-year-old male patient has undergone endoscopic endonasal removal of juvenile nasopharyngeal angiofibroma. The tamponade was removed within the first 24 h postoperatively. Ten hours after it, the patient developed subcutaneous emphysema and pneumomediastinum triggered by sneezing. The diagnosis was confirmed by computed tomography of the neck and chest. The patient was transferred to the intensive care unit and received conservative treatment (including infusion, antibacterial, and antiinflammatory therapy). The symptoms of subcutaneous emphysema and pneumomediastinum subsided in response to treatment. Follow-up examinations (computed tomography and magnetic resonance imaging) confirmed that the tumor had been completely removed. The patient was discharged in a satisfactory condition.Conclusion. Subcutaneous emphysema and pneumomediastinum are exceedingly rare complications of endoscopic endonasal removal of juvenile nasopharyngeal angiofibroma and are caused by anatomical connection between the parapharyngeal / retropharyngeal spaces and mediastinum. To prevent such complications, it is necessary to keep tampons in the nasal cavity for at least 2 days, as well as to instruct patients after surgery (avoid sneezing with their mouth closed, lifting weights, coughing, and vomiting). The nasoseptal flap used to repair the nasopharyngeal defect after tumor removal also ensures its sealing. Patients with complications should undergo computed tomography of the neck and chest (in case of emergency) and should be transferred to an intensive care unit. Conservative treatment (antibacterial and antiinflammatory therapy) will ensure good results in most patients.

Aspiration Pneumonitis with Nasal Liquorrhea. Literature Review

Damage to the meninges in combination with the presence of a defect in the bone structures of the base of the skull and the formation of communication with the nasal cavity or paranasal sinuses are necessary conditions for nasal liquorrhea. There are a number of complications of nasal liquorrhea of various origins: infectious (meningitis, brain abscess), pneumocephalus, aspiration pneumonitis and gastritis. A review of the literature related to aspiration pneumonitis in nasal liquorrhea has been carried out. 4 articles were selected with descriptions of 9 cases. The analysis of demographic indicators of patients, clinical data, treatment characteristics was carried out. Based on the analysis of the literature, aspiration pneumonitis is a rare complication of nasal liquorrhea. For differential diagnosis with other types of pneumonitis, it is necessary to rely on additional clinical data, such as unilateral discharge of clear fluid from the nose when tilting the head, worsening of the condition and intensification of symptoms in a horizontal position, absence of systemic inflammatory response syndrome, ineffectiveness of antibiotic therapy, recurrent the nature of the flow. Antibiotic therapy does not cure the patient from pneumonitis. For the treatment of this pathology, it is first of all necessary to eliminate the cause of aspiration — to perform plastic surgery of the skull base defect in the absence of contraindications from the side of anesthetic aid.

Дифференцированный подход при пластике ликворных фистул в лобной пазухе на основе анализа компьютерных томограмм

The choice of the method of plasty of cerebrospinal fluid fistulas in the area of the frontal sinus is an important issue in neurosurgery, since there are a large number of anatomical variations in the structure of the naso-frontal canal and the sinus itself. Endoscopic, combined and transcranial approaches are described in the literature. However, there is no clear algorithm for choosing a surgical approach for nasal liquorrhea based on anatomical features. The objective of this article is to study various anatomical variants of the structure of the frontal sinus and nasolabial pocket in relation to defects of the base of the skull of a given localization and, based on the data obtained, to establish the patterns of the influence of certain indicators on surgical tactics and the quality of plastic to complement the proposed classification. This article include a retrospective analysis of case histories and computed tomograms of 38 patients who underwent surgical treatment for skull base defects in the frontal sinus region from 2010 to 2020. The patients were divided into three groups depending on the approach used, the features of intraoperative visualization of the defect, and relapses. In a series of 38 cases, the endoscopic approach was used in 26 (68.4 %) cases, combined in 12 (31.6 %) cases. The defect was completely visualized using angled optics during surgery in 32 (84.2 %) cases, and in 6 (15.8 %) cases the defect was not visualized or partially visualized (up to 50 %) using angled optics. Relapses were observed in 6 (15.8 %) cases. The main craniometric indicators affecting the choice of surgical tactics and the quality of plastics are the distance from the center of the defect to the nasal septum, the value of the angle between the nasal septum and the line drawn through the edges of the defect, and the size of the defect. The recurrence rate is directly related to the visualization of the defect during surgery. The distance from the defect to the nasal septum can serve as an objective indicator for choosing access to intermediate defects of the frontal sinus: at a distance of more than 0.95 cm, it is advisable to perform a combined approach; at a distance of less than 0.95 cm, it is possible to achieve full visualization of the defect and perform high-quality plastic surgery with an endoscopic approach. English version of the article on pp. 244-253 is available at URL: https://panor.ru/articles/differentiated-approach-in-frontal-sinus-csf-fistula-plasty-based-on-computed-tomogram-analysis/63924.html

БАЗАЛЬНАЯ ЛИКВОРЕЯ: ВЗГЛЯД ОТОРИНОЛАРИНГОЛОГА

Disruption of the integrity of the liquor space (regardless of the cause) and liquorrhea as a consequence have a high risk of pyo-inflammatory intracranial complications in the patient: the incidence of nasal liquorrhea intracranial complications reaches 25 - 35%. The risk at liquorrhea lasting more than 3 months increases up to 60%, and the development of intracranial complications in a patient in 78.8% of cases was observed more than once. The mortality rate from intracranial complications against the background of basal liquorrhea can be up to 50%. At the same time the incidence of basal liquorrhea, including delayed (a few months or years after injury) is increasing as well as the prevalence of injuries with damage to the skull base including iatrogenic kind is increasing too. Therefore, early diagnosis of liquorrhea is important. An otorhinolaryngologist in his practice may encounter any type of basal liquorrhea: nasal liquorrhea, otoliquorrhea and even orbital liquorrhea. These article based on a literature review and provid recommendations for the primary diagnosis of by head-neck specialists including otorhinolaryngologists.

РИНОСИНУСОГЕННЫЙ МЕНИНГОЭНЦЕФАЛИТ У РЕБЕНКА НА ФОНЕ НАЗАЛЬНОЙ ЛИКВОРЕИ

In modern conditions the number and severity of cranial injuries are increasing, which makes it relevant to study their consequences by specialists of various profiles. One of the most dangerous consequences of open craniocerebral trauma is liquorrhea, both obvious (nasal, ear, orbital, nasopharyngeal) and hidden (in the middle ear cavity, in the paranasal sinuses). According to the time of occurrence after injury, liquorrhea can be immediate or delayed, including after one month more. The frequency of nasal liquorrhea is reaches 30 % in the presence of fractures of the skull base. In the case of the development of liquorrhea, there is a direct communication between subarachnoid space and external environment, which significantly increased the risk of intracranial complications. Therefore, timely diagnosis of this condition is an important task. The article demonstrates clinical case of a developed intracranial complication in a child with liquorrhea in the remote (8 years) period after an open craniocerebral injury. This clinical case demonstrates the need for alertness and awareness of specialists of various profiles about the possible long-term consequences of open craniocerebral trauma.

Case of post-traumatic nasal liquorrhea as a complication of manipulation of biological material sampling for COVID-19

<h3></h3> Частота возникновения назальной ликвореи ятрогенного характера колеблется от 0,5 до 1% всех случаев, основные причины ее возникновения — осложнения хирургических вмешательств в полости носа, в околоносовых пазухах или при любых других манипуляциях в области ситовидной пластинки решетчатой кости. В статье описано редкое клиническое наблюдение назальной ликвореи, возникшей при заборе биологического материала для исследования на COVID-19. Показана необходимость соблюдения особой осторожности при заборе мазков из носа при обследовании на COVID-19, особенно у лиц пожилого возраста.

Rhinitis: differential diagnosis and treatment principles

Rhinitis is inflammation of the mucous membrane inside the nose. The clinical symptoms of this disease include nasal congestion, sneezing, itching of the nose and roof of mouth, rhinorrhea, and mucus draining down the back of the throat. Both allergic and non-allergic factors can play a role in the development of rhinitis. The most commonly used classification of rhinitis includes allergic rhinitis, non-allergic rhinitis, infectious rhinitis, and its specific forms. Allergic rhinitis is classified into the intermittent or persistent types, and may also be classified as mild, moderate and severe according to the severity of symptoms. Treatment of allergic rhinitis includes elimination of contact with allergen, allergen-specific immunotherapy and pharmacotherapy, which is selected depending on the severity of the symptoms. Infectious rhinitis develops in acute viral infection, and rhinitis symptoms are present in acute and chronic rhinosinusitis. Non-allergic rhinitis comprises conditions ranging from vasomotor rhinitis and gustatory rhinitis to non-allergic rhinitis with eosinophilia syndrome. Mixed rhinitis has components of allergic and non-allergic rhinitis. In addition, there are CPAP rhinitis, occupational rhinitis, medication rhinitis, rhinitis in systemic administration of drugs, rhinitis of pregnant women, atrophic rhinitis, rhinitis in systemic diseases. The type of rhinitis is diagnosed based on the patient’s complaints, anamnesis and clinical picture, some cases require laboratory tests and CT scan of the paranasal sinuses to differentiate the diagnosis. Approaches to the treatment of rhinitis depend on its type and include elimination of allergens or provoking factors, administration of saline solutions, intranasal glucocorticosteroids, systemic antihistamines, intranasal cromones, decongestants, antibacterial drugs may be prescribed to treat infectious rhinitis. Rhinitis should be differentiated from structural abnormalities, including congenital features, acquired conditions, neoplasms, gastroesophageal reflux, nasal liquorrhea.

Spontaneous cerebrospinal fluid rhinorrhea in a patient with Pallister–Hall syndrome

Pallister-Hall syndrome (PHS) is extremely rare autosomal dominant disorder with typical clinical features such as presence of polydactyly, hypothalamic hamartoma, bifid epiglottis, anal, renal, genitourinary and pulmonary abnormalities, mainly located in the midline of the body. Spontaneous cerebrospinal fluid (CSF) rhinorrhea is also a rare condition, and it is used to describe nasal discharge of CSF unrelated to previous trauma, localized tumour, surgery, or previous radiation therapy. The exact cause is not yet fully understood.&#x0D; We report a case of adult female patient previously diagnosed with PHS and late onset of spontaneous nasal liquorrhea, due to defect in the anterior skull base. Although it can be incidental finding, we believe that described defect in the body midline can be another presentation of congenital craniofacial abnormality which are common in PHS.

REMOVING A RETROSELLAR PITUITARY ADENOMA VIA THE ENDOSCOPIC ENDONASAL TRANSSPHENOIDAL TRANSCAVERNOUS APPROACH

The study objective is to describe the removal of the pituitary adenoma from the posterior cranial fossa through endoscopic transsphenoidal trans-cavernous approach, when the main surgical corridor was the tumor-intact cavernous sinus. Materials and methods. A 55-year-old male patient with endosupraretrosellar endocrine-inactive pituitary adenoma was admitted to N.N. Burdenko Research Center of Neurosurgery. The patient had earlier undergone two surgeries for pituitary adenoma. Using the endoscopic endonasal transsphenoidal approach, we found that these surgeries resulted in the formation of scar-altered adipose tissue in the sphenoid sinus and partly in the sella turcica; anatomical landmarks indicating the midline and the location of the internal carotid arteries were absent. We formed an access to both retro- and suprasellar portions of the tumor between the sella turcica and cavernous segment of the internal carotid artery (through the cavernous sinus); then we dissected anterior and posterior walls of the sinus and revealed a soft capsule-free pituitary adenoma, which was completely removed by a vacuum aspirator. The skull base defect was repaired using the multilayer technique with autologous tissues. Results. After surgery, neurological status and visual functions did not change. In the postoperative period, we observed no oculomotor disorders, pituitary insufficiency, diabetes insipidus, or nasal liquorrhea. Follow-up computed tomography scans revealed no signs of intracranial complications or obvious residual tumor tissue. Magnetic resonance imaging 4 month postoperatively demonstrated small laterosellar fragments of the tumor in the sella turcica. The patient was further followed up. Conclusion. Cavernous sinus is a natural anatomical corridor providing access to the structures of the posterior cranial fossa and interpeduncular cistern. The main risk (damage to the cavernous segment of the internal carotid artery) can be minimized by using intraoperative dopplerography and visual control of all manipulations.

Transsphenoidal endoscopic appro ach in the treat ment of spontaneous cerebrospinal fluid (CSF) leak

Introduction. Spontaneous nasal liquorrhea is a pathological condition associated with defect between nasal cavity and intracranial structures that lead to the expiration of the CSF from the nasal cavity.The objective is to evaluate the effectiveness of endoscopic endonasal approach in the CSF leak treatment.Material and methods. For the period from 2008 to 2018, 38 patients with spontaneous nasal liquorrhea were examined and treated in Pavlov First Saint Petersburg State Medical University, the clinic of neurosurgery of Kirov Medical Institute and Almazov National Medical Research Centre. All patients underwent plastic surgery of the CSF fistula by endoscopic endonasal aproach.Results. Only in 4 cases, there was a large defect, the failure of the closure of which required repeated surgical intervention in 1–2 weeks after the initial operation.Conclusion. The use of autologous tissues (muscle or fat autograft) is the method of choice for repeated surgical plastics of the cerebrospinal fluid fistula or in a large size defect (more than 5 mm).

Transcranial decompression of the optic nerve channels in meningiomas of the chiasmal-cellar region: efficiency, risks and complications

The study objective is evaluate the effectiveness and risks of using intradural and extradural decompression of the optic nerve channels during standard transcranial removal of meningiomas of the chiasmal-cellar region region. Materials and methods. The results of 161 decompression of channel of optic nerve in 129 patients are analyzed. In most patients (n = 122), an intradural decompression (resection) of the canal roof was performed. In 7 patients, an extradural decompression of the upper and lateral walls of the canal was performed. Results. In assessing the risks of visual impairment as a result of channel decompression, we found that decompression itself, without attempts to separate the tumor from the nerve, causes vision impairment in 8.6 % of cases. Attempts to separate the tumor from the optic nerves increase the risk of vision impairment from 16.7 to 26.9 %, depending on the radicality. Conclusion. A small number of complications (iatrogenic amaurosis and nasal liquorrhea) make it possible to recommend the described technique as an effective and safe addition to standard transcranial operations to remove the meningiomas of the chiasmal-cellar region.

Modern aspects of surgical treatment of nasal liquorrhea with localization of defect in frontal sinus

To summarize and to analyze the results of treatment of nasal liquorrhea with localization of the defect in the frontal sinus using endoscopic endonasal and combined intra-extranasal approaches. A retrospective analysis of a series of 43 cases of nasal liquorrhea with a frontal sinus defect being treated at the NMRCN Burdenko during the period from 2001 to 2017. To select access, a classification of frontal sinus defects according to their localization was developed. The analysis of demographic and clinical data of patients, as well as intraoperative and postoperative data analysis were done. In the series of 43 patients, endoscopic endonasal approach was performed in 28 (65%) cases. Combined approach was performed at 15 (35%) patients. The success rate of plastic surgery with endoscopic endonasal approach was 86% (24 of 28), with combined approach - 93% (14 of 15). Endoscopic endonasal and combined approaches are the methods of choice for plastic surgery of defects of the skull base in the frontal sinus as they are effective and safe. The choice of approach depends on anatomical features of the frontal sinus and on the localization of defect.

Transsphenoidal Endoscopic Approach in Treatment of Spontaneous Nasal CSF-leak

Spontaneous nasal liquorrhea is a pathological condition associated with defects between the nasal cavity and the intracranial structures, which results in CSF leak from the nasal cavity. Diagnostic criteria include: anamnesis, examination of the nasal fluid, endoscopic examination of the nasal cavity, and CT - and MRI - cisternography. Conservative therapy is applicable to small fistulas. In the case of the inefficiency of this method, surgical method is then applied to the defect closure. Purpose of the study: To evaluate the effectiveness of endoscopic endonasal approach in the CSF leak treatment. Materials and methods: For the period from 2008 to 2018 at the Pavlov First Saint Petersburg State Medical University, at the clinic of neurosurgery of the Kirov Medical Institute and the Medical Research Center Almazov, 38 patients with spontaneous nasal liquorrhea were treated. All patients underwent plastic surgery of the CSF fistula by endoscopic endonasal approach. Results: In 4 cases, there was a large defect requiring secondary surgical intervention 1-2 weeks after the initial operation. Conclusions: The use of auto tissues (muscle or fat) is the method of choice for repeated surgical plastics of the cerebrospinal fluid fistula or in the case of a large size defect.

A modern approach to the diagnosis of nasal liquorrhea

The study purpose was to review and comparatively analyze all modern methods of diagnosing nasal liquorrhea as well as to substantiate the most effective and promising approaches and algorithms. The study included papers in English and Russian found in the Pubmed database and related to the diagnosis of basal liquorrhea of different etiology and localization. This review demonstrates that diagnostic tests vary widely in sensitivity, specificity, accuracy, invasiveness, and cost. Given all the criteria, detection of beta-2 transferrin or beta-trace protein is the best method for confirming nasal liquorrhea, and high-resolution computed tomography is the best technique for localization of the abnormality. Based on the review, we suggest a diagnostic algorithm for nasal liquorrhea. However, the evidence presented in this review is unfortunately not very reliable, which indicates the existing need for more accurate studies.