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.
Key words
Rhinorrhea - craniotomy - extracranial repair - endoscopic surgery
References
- 1
Probst C.
Neurosurgical treatment of traumatic frontobasal CSF fistulae in 300 patients (1967
- 1989).
Acta Neurochir (Wien).
1990;
106
37-47
- 2
Hubbard J L, McDonald T J, Pearson B W, Laws E R.
Spontaneous cerebrospinal fluid rhinorrhea: Evolving concepts in diagnosis and surgical
management based on the Mayo Clinic experience from 1970 through 1981.
Neurosurgery.
1985;
16
314-321
- 3
Gates T, Frodel J L.
Frontobasilar blast injuries: access and treatment.
J Craniomaxillofac Trauma.
1998;
4
32-39
- 4
McCormack B, Cooper P R, Persky M, Rothstein S.
Extracranial repair of cerebrospinal fluid fistulas: Technique and results in 37 patients.
Neurosurgery.
1990;
27
412-417
- 5
Fliss D M, Zucker G, Cohen J T, Gatot A.
The subcranial approach for the treatment of cerebrospinal fluid rhinorrhea: A report
of 10 cases.
J Oral Maxillofac Surg.
2001;
59
1171-1175
- 6
Klotch D W, Patel N, Dussia E.
Evolution of the extracranial approach for repair of CSF leaks: review of the literature
and clinical cases.
J Oral Maxillofac Trauma.
1998;
4
30-35
- 7
Wigand M E.
Transnasal ethmoidectomy under endoscopical control.
Rhinology.
1991;
19
7-15
- 8
Zweig J L, Carrau R L, Celin S E, Schaitkin B M, Pollice P A, Snyderman C H, Kassam A,
Hegazy H.
Endoscopic repair of cerebrospinal fluid leaks to the sinonasal tract: predictor of
success.
Otolaryngol Head Neck Surg.
2000;
123
195-201
- 9
Gassner H G, Ponikau J U, Sherris D A, Kern E B.
CSF rhinorrhea: 95 consecutive surgical cases with long-term follow-up at Mayo Clinic.
Am J Rhinol.
1999;
13
439-447
- 10
Lund V J.
Endoscopic management of cerebrospinal fluid leaks.
Am J Rhinol.
2002;
16
17-23
- 11
Dandy W E.
Pneumatoceles (intracranial pneumatocele or aerocele).
Arch Surg.
1926;
12
949-982
- 12
Dohlman G.
Spontaneous cerebrospinal rhinorrhea. Operated by rhinologic methods.
Acta Otolaryngol.
(Stockh) 1948;
67 (suppl)
20-23
- 13
Montgomery W W.
Surgery of cerebrospinal fluid rhinorrhea and otorrhea.
Arch Otolaryngol.
1966;
84
92-104
- 14
Calcaterra T C.
Exracranial surgical repair of cerebrospinal rhinorrhea.
Ann Otolaryngol.
1980;
89
108-116
- 15
Tosun F, Carrau R L, Snyderman C H, Kassam A, Celin S, Schaitkin B.
Endonasal endoscopic repair of cerebrospinal fluid leaks of the sphenoid sinus.
Arch Otolaryngol Head Neck Surg.
2003;
129
576-580
- 16
Lanza D C, O'Brien D A, Kennedy D W.
Endoscopic repair of cerebrospinal fluid fistulae and encephaloceles.
Laryngoscope.
1996;
106
1119-1125
- 17
Gjuric M, Goede U, Keimer H, Wigand M E.
Endonasal endoscopic closure of cerebrospinal fluid fistulas at the anterior cranial
base.
Ann Otol Rhinol Laryngol.
1996;
105
620-623
- 18
Dodson E E, Gross C W, Sterdloff J L, Gustafson L M.
Transnasal endoscopic repair of cerebrospinal fluid rhinorrhea and skull base defects:
a review of twenty-nine cases.
Otolaryngol Head Neck Surg.
1994;
111
600-605
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: fuattosun@yahoo.com