Endoscopic endonasal multilayer repair of traumatic CSF rhinorrhea

Abstract

The incidence of traumatic CSF has increased in recent years due to increased incidence of road traffic accidents (RTA) as well the increasing number of endoscopic sinus surgeries (ESS). The objective of this study is to present our experience in management of traumatic CSF leaks using the endoscopic multilayer repair technique. Forty-two patients (aged 10-75 years, 30 males and 12 females) presenting with confirmed post-traumatic CSF rhinorrhea were operated upon between January 2007 and December 2013. The endoscopic multilayer technique was used in all cases. Electromagnetic navigation was used in some cases. All cases presented with intermittent watery rhinorrhea. The duration of the rhinorrhea ranged from 3 days to 1 year before repair. One case presented after 10 years from the causative trauma. Ten cases had a history of meningitis. Nine cases had more than one defect. Iatrogenic defects were larger than defects following accidental trauma. Two cases, following RTA, developed pseudo-aneurysm of internal carotid artery. Ten cases had associated pneumocephalus. The mean duration of postoperative hospitalization was 6 days (range 4-8 days). The mean follow-up duration was 31.2 +/- 11.4 months (range 16-48 months). None of our patient developed serious intra- or postoperative complications. Only one case required another surgery to repair a missed second defect. Post-traumatic CSF leaks can be successfully managed via the endonasal endoscopic route using the multilayer repair technique. It is important to look for multiple defects in these cases. CT angiography is recommended for traumatic leaks involving the lateral wall of the sphenoid sinus to diagnose or exclude the development of pseudo-aneurysm of the internal carotid artery.

Endoscopic Endonasal Repair of Sphenoid Sinus Cerebrospinal Fluid Leaks: Our Experience

“…Heterologous materials recommended include equine collagen matrix, fibrin glue and polytetrafluoroethylene foam. Multi-layered techniques are reported to have better results [1,3,15]. Hadad-Bassagasteguy flap (vascular pedicled nasoseptal flap) is a robust reconstructive option for skull base defects with near 100 % survival rate [16,17].…”

“…Idiopathic CSF leaks are the rarest of CSF leaks and are often a diagnosis of exclusion. The defects may be located anywhere in the ventral skull base which includes the cribriform plate, fovea ethmoidalis, sphenoid bone, temporal bone or posterior table of frontal sinus [1].…”

ICAR: endoscopic skull‐base surgery

“…Multiple defects were identified in 6 of 10 cases of accidental trauma, 2 of 12 following endoscopic sinus surgery, and 1 of 5 cases following anterior skull‐base surgery. The primary success rate was 97%, with only 1 case requiring secondary repair . Virk et al .…”

“…However, endoscopic repair of traumatic CSF leaks is a well‐accepted treatment with a low complication rate. {Banks, 2009 #3115}…”

Endoscopic Transnasal Repair of Cerebrospinal Fluid Rhinorrhea - Analysis of 400 Cases

“…Nearly 80% of CSF leaks occur as a result of accidental trauma, 16% are iatrogenic and only 4 % due spontaneous leaks. The defects may be located in cribriform plate fovea ethmoidalis, sphenoid bone or posterior table of frontal sinus [2] .…”