Minim Invasive Neurosurg 2005; 48(6): 355-360
DOI: 10.1055/s-2005-915636
Original Article
© Georg Thieme Verlag Stuttgart · New York

Analysis of Different Surgical Approaches for the Treatment of Cerebrospinal Fluid Rhinorrhea

F.  Tosun1 , E.  Gonul2 , S.  Yetiser1 , M.  Gerek1
  • 1Department of ORL & HNS, Gülhane Medical School, Etlik, Ankara, Turkey
  • 2Department of Neurosurgery, Gülhane Medical School, Etlik, Ankara, Turkey
Further Information

Publication History

Publication Date:
23 January 2006 (online)

Abstract

The current treatment method for cerebrospinal fluid (CSF) rhinorrhea is surgical repair of the fistula. The aim of this study was to analyse different surgical approaches used for the treatment of CSF rhinorrhea regarding several preoperative and postoperative variables to determine the optimal method in these patients. Patients' charts were retrospectively reviewed to get the required data. Twenty-six patients who underwent different types of surgical approach for the treatment of CSF rhinorrhea were included in the study. Patients who had extensive comminuted fractures of the anterior cranial base and additional brain injury besides CSF rhinorrhea, mostly as a result of gunshot injuries, underwent craniotomy (n = 14). Osteoplastic frontal sinusotomy was used in two patients with a dural defect located at the posterior wall of the frontal sinus. Uncomplicated CSF fistulas in ten patients, located at the anterior and posterior ethmoid roof and in the sphenoid sinus, were closed with an endonasal endoscopic approach. Postoperative success rate was higher (97 % for intracranial approach, 100 % for extracranial external and endonasal endoscopic approach) for all techniques. Anosmia was the most frequent permanent complication (n = 5), seen after craniotomy. In conclusion, endonasal endoscopic approach can be preferred for the closure of uncomplicated CSF fistula, located at the anterior or posterior ethmoid roof and in the sphenoid sinus, due to its minimal postoperative morbidity. Uncomplicated CSF fistula, located at the posterior wall of frontal sinuses can be repaired extradurally with osteoplastic frontal sinusotomy. Intracranial approaches should be reserved for more complicated CSF rhinorrhea which results from extensive comminuted fractures of the anterior cranial base and is accompanied with intracranial complications.

References

Fuat Tosun, , M. D., Associate Professor 

Department of ORL & HNS

Gülhane Medical School

Etlik · 06018 Ankara

Turkey ·

Phone: +90-312-304-5701

Fax: +90-312-304-5700

Email: [email protected]