Long-Term Study of Endonasal Duraplasty and Review of the Literature

Abstract

Many different techniques have been proposed to repair frontobasal dura mater lesions. Because of its low morbidity and high success rate, the endonasal approach has become a preferred route for treating cerebrospinal fluid fistulas of the anterior skull base. This article presents a retrospective evaluation of 136 endonasal duraplasties (126 patients) performed between July 1980 and May 1998 at a tertiary care facility. Follow-up consisted of clinical examinations including nasal endoscopy, objective measures, and telephone interviews. The following measures were used to evaluate the results of these duraplasties: postoperative nasal fluorescein endoscopy in 71 cases, computed tomographic cisternography in 2, nasal fluorescein endoscopy with computed tomographic cistemography in 19, magnetic resonance imaging in 6, and nasal fluorescein endoscopy with magnetic resonance imaging in 1. Tight closure was accomplished in 129 dural lesions (94.9%) on the first attempt. In 3 cases, recurrence of cerebrospinal fluid leakage was treated successfully by 1 endonasal revision, and in 1 case, a tight duraplasty was achieved after 2 endonasal revisions. Its high success rate, low rate of morbidity, and good long-term results recommend endonasal duraplasty as a primary treatment modality for frontobasal dural lesions. For extended frontobasal dural lesions, for which intracranial dural repair is the preferred approach, the endonasal approach should be used to close additional dural leaks of the sphenoid sinus.

Correção endoscópica de fístula liquórica rinogênica: experiência de 44 casos

“…During preoperative evaluation and in order to locate the lesions site, all patients were submitted to compute tomography, with axial and coronal sections of paranasal sinuses. We have not used B2-transferrin, which is the most sensitive test to confirm SF leakage 5 , since it was not available, while magnetic resonance (MRI) was requested only for suspected cases of meningoencephaloceles, differently from Nachtigal and Schick studies, which proposed MRI for all cases 2,4 .…”

“…1,2 . Saintclair Thompson reported the first series of patients with spontaneous leakage in 1889 1 .…”

“…Saintclair Thompson reported the first series of patients with spontaneous leakage in 1889 1 . Many attempts to correct a SF leak were done in the 20 th Century, although the first well-succeeded surgical approach was attributed to Dandy in 1926, when he sutured the fascia lata over dural defect, on back of the posterior wall of the frontal sinus, by intracranial route 2 . In 1964, Vrabec and Hallberg described endonasal approach to repair a SF leak in the cribriform lamina 2,3 .…”

“…In addition, presence of SF may be a risky condition for patient and onset of infections in the central nervous system, such as meningitis 2,4 . Thus, in the absence of spontaneous resolution, a corrective procedure should be performed.…”

“…Thus, endonasal duraplasty has been successfully used to repair several dura mater lesions with low patient's morbidity rate 2,6,7 .…”