Surgical Repair of Cerebrospinal Rhinorrhea in a Resource-Poor Practice: A Clinical Case Illustrated Technical Report

Objective: In the developing countries where surgical endoscopy is still not readily available, intracranial surgery remains the only pragmatic option for repairing cerebrospinal fluid (CSF) rhinorrhea. Even such surgery can be forbiddingly difficult in a resource-poor setting.

Design: A simple intracranial extradural surgical technique used in a developing country for the frontobasal repair of CSF rhinorrhea is presented. This involves the dissection, preservation, elevation, and extradural imbrication of a wide-based pericranial flap to seal dural leaks and also exclude the frontobasal intracranial space from the naso-orbital roof.

Patients/Materials and Methods: Preoperative clinical-radiological characteristics and postoperative outcome of a prospective consecutive case series of CSF rhinorrhea repaired with this technique shall be presented.

Results: Over an 18-month period, six consecutive cases of CSF rhinorrhea in an African developing country were successfully repaired with this technique. Five of them were from posttraumatic complex skull base fracture with associated tension pneumocephalus. Cessation of CSF leak was immediate in all six cases. Anosmia was the only procedure-related complication to date. No other perioperative adjunct was used to aid this surgical outcome. Recurrence of CSF leak has been nil in a follow-up period ranging from 1 to 18 months (mean, 9 months).

Conclusions: This simple surgical technique appears effective for the surgical repair of frontobasal CSF leak. It holds great attraction for skull base surgical practice in resource-poor settings.