Management of cerebrospinal fluid rhinorrhea: an evidence‐based review with recommendations

Oakley, Gretchen M.; Orlandi, Richard R.; Woodworth, Bradford A.; Batra, Pete S.; Alt, Jeremiah A.

doi:10.1002/alr.21627

Cited by 85 publications

(78 citation statements)

References 85 publications

(155 reference statements)

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“…16 Multiple studies have investigated the use of lumbar drains in endoscopic repairs of CSF leak; some concluded that they do not appear to affect the repair rates, 5 or could not ascertain their benefits, 6 and others found that they do not significantly contribute to the success of surgical repairs. 17,18 Most studies in this field included patients with different eitiologies predisposing them to CSF leaks. In a study by Albu et al in which lumbar drains and their effects on recurrence were assessed.…”

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confidence: 99%

The Effect of lumbar drains on spontaneous cerebrospinal fluid leak repair

Doubi

Aljomah

Alhargan

et al. 2018

NSJ

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Objectives: To address the factors affecting recurrence after endoscopic surgical repairs of spontaneous cerebrospinal fluid leak, specifically the influence of using lumbar drains. Methods: This study involved a retrospective data analysis, including a chart review of all spontaneous cerebrospinal fluid (CSF) leak cases who underwent endoscopic anterior skull base repair from 2012-2017 in King Fahad Medical City, Riyadh, Kingdom of Saudi Arabia. Original Articles Results: Thirteen patients with spontaneous CSF leaks were identified and evaluated. The majority were females (92.3%) with an average body mass index of 34.9. All patients underwent endoscopic repair with intra-operative lumbar drain placement. Patients continued having post-operative lumbar drain for an average of 6.4 days. Four patients (30.8%) developed recurrence; however, only one of those had a documented high opening pressure. Conclusion: Spontaneous CSF leak repairs are at a higher failure risk and may have an underlying pathology involving CSF circulation. The use of lumbar drains and intracranial pressure lowering agents are controversial and seems to be reserved only for high risk patients; however, the higher risk of recurrence in this group may be better managed by proper pre-operative evaluation and selective, patientspecific management protocols.

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confidence: 99%

The Effect of lumbar drains on spontaneous cerebrospinal fluid leak repair

Doubi

Aljomah

Alhargan

et al. 2018

NSJ

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“…To date, according to the systematic review by Oakley et al in 2015, there is no aggregate evidence level which can be generated from the available literature to review many adjunctive historic conservative measures. 27 In 2001, a survey of otolaryngologists managing CSF leaks from skull base trauma reported that two-thirds were using lumbar drains routinely. 28 In 2012, Psaltis et al could not ascertain from their meta-analysis the number of cases using lumbar drains, their indications, or their effectiveness.…”

Section: Conservative Managementmentioning

confidence: 99%

Contemporary Trends in the Management of Posttraumatic Cerebrospinal Fluid Leaks

Mourad

Inman

Chan

et al. 2018

Craniomaxillofacial Trauma & Reconstruction

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“…It can occur following skull base trauma, endoscopic sinus surgery, or neurosurgical procedures, or have a spontaneous etiology [1]. The most common symptom of CSF leak is rhinorrhea.…”

Section: Introductionmentioning

confidence: 99%

Multilayered Closure of Cerebrospinal Fluid Rhinorrhea with Inlay Fascia Lata, Autologous Fat, and Outlay Fascia Lata: Our Experience

Eryılmaz

Arıcıgil²,

Alan³

2016

ORL

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Background/Aims: Since the initial use in 1981 by Wigand, different endoscopic endonasal surgery techniques have been proposed to close ventral skull base defects, all of which include multilayer closure involving vascularized mucoseptal flaps, autologous grafts, and synthetic materials. These methods are used individually or in combination, as required by the operative condition. Methods: In this study we aimed to describe our endoscopic technique using inlay-outlay fascia lata and autologous fat with fibrin sealant to close spontaneous and traumatic cerebrospinal fluid (CSF) rhinorrhea. Results and Conclusion: Twenty-one CSF rhinorrhea patients were operated with this technique in our hospital. Two patients had large skull base defects and 15 patients had high-flow CSF leaks. We reached a 100% success rate in the first attempt without any long-term recurrence. Multilayered endoscopic closure with this technique offers satisfactory results with minimal morbidity even in large defects and high-flow CSF leaks.

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Management of cerebrospinal fluid rhinorrhea: an evidence‐based review with recommendations

Abstract: Despite relatively low levels of evidence, recommendations for the management of CSF rhinorrhea can be made based on the current literature. Higher-level studies are needed to better determine optimal clinical management approaches.

Cited by 85 publications

References 85 publications

The Effect of lumbar drains on spontaneous cerebrospinal fluid leak repair

The Effect of lumbar drains on spontaneous cerebrospinal fluid leak repair

Contemporary Trends in the Management of Posttraumatic Cerebrospinal Fluid Leaks

Multilayered Closure of Cerebrospinal Fluid Rhinorrhea with Inlay Fascia Lata, Autologous Fat, and Outlay Fascia Lata: Our Experience

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