DOI: http://dx.doi.org/10.18203/issn.2454-5929.ijohns20204617

Endoscopic trans nasal intervention in cerebrospinal fluid rhinorrhea: a one and half-year pilot study

Manish Munjal, Anmol R. Kath, Rakesh Kaushal, Arpit Kaushal, Shubham Munjal, Shivam Kalra, Anurima Arora

Abstract


Background: Cerebrospinal rhinorrhea from the anterior and middle skull base was repaired through the inferior intra-nasal corridor under high resolution endoscopic visualization. The sites, tissues utilized and the surgical outcome have been critically analyzed.  

Methods: 47 subjects of skull base lesions underwent surgical intervention jointly in the Departments of Otolaryngology and Neurosurgery, Dayanand Medical College and Hospital, Ludhiana during a period of 1.5 year.  

Results: Trans-nasal endoscopic intervention for cerebrospinal fluid rhinorrhea was undertaken in 1 male (14.3%) and 6 female (85.7%) patients. The minimum age in our study was 28 years and maximum 68 years with mean age 49.9 years. 6 (85.7%) patients had a history of spontaneous cerebrospinal fluid leak while 1 (14.3%) had a history of trauma prior to the leak. The body mass index (BMI) of 6 (85.7%) was in the range of 30.0–34.9.              Total 6 (85.7%) patients of cerebrospinal fluid leak presented with rhinorrhea or watery nasal discharge as the chief complaint. The cribriform plate, as seen in 5 (71.4%) patients, was the predominant site of cerebrospinal fluid rhinorrhea, followed by the sphenoid, 2 (28.6%) and the fovea ethmoidalis 1 (14.3%). The tissue utilized as graft were fascia lata (7 patients), nasoseptal flap also known as the Hadad-Bassagasteguy flap (5 patients) and middle turbinate mucosa                 (1 patient).  

Conclusions: Spontaneous leaks from the cribriform plate outnumbered traumatic leaks male to female ratio was higher 1:6 in the 5th decade. Hadad-Bassagasteguy flap (in isolation or with fascia lata graft) as reconstructive material is used more commonly as compared to fascia lata.  


Keywords


CSF leak, Skull base, Endoscopic repair, Fascia lata

Full Text:

PDF

References


Husain M, Jha D, Vatsal DK, Husain N, Gupta RK. Neuroendoscopic transnasal repair of cerebrospinal fluid rhinorrhea. Sku Bas. 2003;13(2):73.

Hanna Gilat MD, Zvi Rappaport MD, EitanYaniv MD. Endoscopic transnasal cerebrospinal fluid leak repair: a 10 year experience. Isra Medic Assoc J. 2011;13:597-600.

Dunn CJ, Alaani A, Johnson AP. Study on spontaneous cerebrospinal fluid rhinorrhoea: its etiology and management. J Laryngol Otol. 2005;119(1):12.

Citardi MJ, Fakhri S. Cerebrospinal fluid rhinorrhea. Cummin Otolaryngol Head Neck Surg. 2010;5:785-96.

Rudnick E, Sismanis A. Pulsatile tinnitus and spontaneous cerebrospinal fluid rhinorrhea: indicators of benign intracranial hypertension syndrome. Otol Neurotol. 2005; 26(2):166-8.

Sannareddy RR, Rambabu K, Kumar VE, Gnana RB, Ranjan A. Endoscopic management of CSF rhinorrhea. Neurol Ind. 2014; 62(5):532.

Schlosser RJ, Woodworth BA, Wilensky EM, Grady MS, Bolger WE. Spontaneous cerebrospinal fluid leaks: a variant of benign intracranial hypertension. Ann Otol Rhinol Laryngol. 2006; 115(7):495-500.

Hegazy HM, Carrau RL, Snyderman CH, Kassam A, Zweig J. Transnasal endoscopic repair of cerebrospinal fluid rhinorrhea: a meta‐analysis. Laryngosco. 2000;110(7):1166-72.

Sautter NB, Batra PS, Citardi MJ. Endoscopic management of sphenoid sinus cerebrospinal fluid leaks. Ann Otol Rhinol Laryngol. 2008;117(1):32-9.

Cassano M, Felippu A. Endoscopic treatment of cerebrospinal fluid leaks with the use of lower turbinate grafts: a retrospective review of 125 cases. Rhinol. 2009;47(4):362.

Wagenmann M, Schipper J. The transnasal approach to the skull base. From sinus surgery to skull base surgery. GMS current topics in Otorhinolaryngol Head Neck Surg. 2011;10