Endoscopic repair of CSF rhinorrhea: An institutional experience

Sarita Kumari Mishra, George Ani Mathew*, Roshna Rose Paul, Syed Kamran Asif, Mary John, Ajoy Mathew Varghese, Mary Kurien

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

7 Citations (Scopus)

Abstract

Introduction: Endoscopic repair is considered the treatment of choice in cerebrospinal fluid (CSF) rhinorrhea. The aim of our study was to analyze the etiopathogenesis of CSF rhinorrhea, the outcome of treatment and the causes of failure in a developing-country setting. Materials and Methods: A retrospective review of patients treated with endoscopic repair for CSF rhinorrhea at a tertiary care hospital in southern India from January 2002 to December 2009 identified 36 patients, the majority of them being women. The defects were closed in three layers using fat, fascia lata and nasal mucosa along with a fibrin sealant in the majority of the patients. Per-operatively, a subarachnoid drain was placed in all patients. Patients were followed up for 1 year. Results: Spontaneous onset of CSF rhinorrhea was noted in 61% of patients. The most common site of leak was found to be the left cribriform plate area. Hence the most common cause of CSF rhinorrhea in our study was spontaneous and the second most common was post-traumatic. Our success rate on the first attempt at endoscopic repair was 100%, with a recurrence rate of 6%. A large defect, failure of localization of the defect, or other co-morbid conditions such as chronic cough may be the most likely causes of recurrence of leak. Conclusion: Accurate localization of the site of lesion using a high-resolution computed tomography (CT) scan with magnetic resonance imaging (MRI) and confirmation of the site of leak by intraoperative Valsalva maneuver along with multilayered closure of the dural defect and post-operative lumbar drain appear to be essential for the successful endoscopic repair of CSF rhinorrhea.

Original languageEnglish
Pages (from-to)39-43
Number of pages5
JournalIranian Journal of Otorhinolaryngology
Volume28
Issue number1
Publication statusPublished - Jan 1 2016

Keywords

  • Cribriform plate
  • CSF rhinorrhea
  • Subarachnoid Space
  • Transnasal Endoscopic Surgery
  • Valsalva Maneuver

ASJC Scopus subject areas

  • Otorhinolaryngology

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