Efficacy of Transnasal Endoscopic Surgery for CSF Rhinorrhea

Objective: To assess the efficacy of transnasal endoscopic repair of the skull base for CSF rhinorrhea.

Design: Retrospective study.

Patients/Materials and Methods: Twenty-two consecutive patients were included in this study. The selected patients had spontaneous, nonhealing, traumatic CSF rhinorrhea, had undergone transnasal endoscopic repair of the skull base between1999 and 2011, and were available for a minimum follow-up period of 6 months. The hospital records of these patients were analyzed for the etiology and site of leak, technique of repair, morbidity, complications, and success rate.

Results: Eighteen of the 22 cases had spontaneous CSF rhinorrhea, and the rest had history of trauma (head injury in 3 and nasal surgery in1). All had unilateral CSF leak. All except 7 cases had the leak from the medial aspect of fovea ethmoidalis near the anterior ethmoidal artery. Five patients had leak from cribriform plate, and two had leak from a defect in the sphenoid skull base. The leak site was repaired in all cases by temporalis fascia and nasal septal cartilage; a few also underwent septal/middle turbinate flap. Sphenoid leaks were also repaired with fat. Anterior nasal packing was done in all cases and was removed in an average of 3 days. Average duration of surgery was 73 minutes, and average duration of hospitalization was 3 days. All had successful closure of the leak, clinically as well as endoscopically.

Conclusions: Endoscopic endonasal surgery for CSF rhinorrhea has a high success rate with low morbidity and low complication rate.