Repair Of Cerebrospinal Fluid Fistula Research Articles

Extracranial Repair of Cerebrospinal Fluid Fistulas: Technique and Results in 37 Patients

Although neurosurgeons have traditionally preferred intracranial repair for the management of cerebrospinal fluid (CSF) fistulas, this approach is associated with the complications of a craniotomy, anosmia, and a high incidence of recurrent fistulas. Extracranial repair, on the other hand, produces no central nervous system morbidity, preserves olfaction, and is associated with a low incidence of recurrence. Although there have been several reports of extracranial repair of CSF fistulas by otorhinolaryngologists, this approach has received scant mention in the neurosurgical literature. We report here our experience with 37 patients with CSF rhinorrhea or otorrhea who underwent extracranial repair. The etiology of the fistula was postoperative in 22, traumatic in 6, and spontaneous in 9. The fistulas were repaired using one of four techniques: external ethmoid-sphenoid in 18 patients, transmastoid in 9, transseptosphenoid in 7, and osteoplastic frontal sinusotomy in 3. In 32 of the 37 patients (86%) the fistulas were successfully repaired with the initial procedure. Of the 5 patients requiring a second operation, the fistula was successfully closed in 4 for an overall success rate of 97%. Complications were few and consisted of a transient facial paresis in a patient undergoing transmastoid repair and one death from meningitis. The authors conclude that because of low morbidity and mortality and a high success rate in closing fistulas, extracranial repair is the preferred technique for the operative management of CSF rhinorrhea and otorrhea.

Repair of cerebrospinal fluid fistulas using a tissue adhesive.

✓ Isobutyl 2-cyanoacrylate (IBC) is the outstanding compound presently available for use as a tissue adhesive. One of the greatest needs for a biologic glue in neurosurgery is in the repair of cerebrospinal fluid fistulas. Experience with 14 such cases at the Walter Reed Army Hospital using the technique described shows that IBC is both safe and effective.

Endoscopic transnasal repair of CSF rhinorrhea: Techniques and out come

Background: Endoscopic transnasal repair of CSF (Cerebro Spinal Fluid) fistula is safe, effective and widely accepted minimally invasive procedure. We describe our experience of techniques and result of endonasal CSF fistula repair along with its safety and effectiveness as well as low complications. Method: All patients who underwent endonasal CSF fistula repair from July ’07 to September ’09 in the department of Neurosurgery, Dhaka Medical College Hospital & Islami Bank Central Hospital, Dhaka, Bangladesh were prospectively analyzed. Patients were followed up for average period of 10.2 months (Range: 3 to 30 months). Results: The age range was 12 years to 55 years; male -female ratio was 5:8. Clinical features were single nose rhinorrhea, double nose rhinorrhea, anosmia, history of trauma, history of transsphenoidal pituitary surgery, recurrent meningitis, aspiration pneumonia and insomnia, obesity and skeletal dysplasia. Etiology of CSF Fistula were idiopathic-06, congenital hydrocephalus-01, post head injury (traumatic)-05 and post surgical-01case. Anatomical sites of fistula that we found in our series were cribriform plate-06, posterior ethmoidal-04, planum sphenoidalae-02 and sellar-01. Post operatively, 2 patients complained of foul smelling within nose and 1 case had persistent CSF rhinorrhoea, where we over looked a frontal sinus fistula and was closed transcranially later on. There was partial nasal obstruction in 01 case that resolved after a year. New anosmia developed in 01 case after operation. Mortality was nil. Out of 13 transnasal endoscopic repair of CSF fistula 12 cured and 01 persisted (that was retreated by transcranial approach) Conclusion: Endoscopic transnasal CSF fistula repair is associated high success rate of fistula closure along with very few complications; at the same time it is minimally invasive, less traumatic and patient-friendly. So it is our notion that it should be the preferred approach to CSF fistula due to defect in anterior skull base and sellar floor. Key Words: Endoscopic Transnasal; CSF fistula; CSF rhinorrhea. DOI: 10.3329/bjo.v17i1.7618 Bangladesh J Otorhinolaryngol 2011; 17(1): 14-20