Surgical management of cerebrospinal fluid rhinorrhea under endoscopic control

Landeiro, José Alberto; Flores, Marlo Steiner; Lázaro, Bruno C.R.; Melo, Maria Helena

doi:10.1590/s0004-282x2004000500016

Cited by 23 publications

(11 citation statements)

References 25 publications

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“…Contraindications to the endoscopic treatment of CSF fistulas in− clude the presence of an intracranial lesion, a fracture of the pos− terior wall of the frontal sinus, lateral extensions of the frontal si− nus and CSF rhinorrhea from a temporal bone defect [20].…”

Section: Discussionmentioning

confidence: 99%

Endoscopic Endonasal Approach for Cerebrospinal Fluid Fistulae

Silva

Santos

Zymberg

2006

Minim Invasive Neurosurg

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Different techniques have been proposed to repair cerebrospinal fluid rhinorrhea. Advances in nasal surgery led to a high success rate and low morbidity for the endonasal approach. It has become the favorite route for treating cerebrospinal fluid leaks of the anterior skull base. Better results have been obtained with the improvement of rigid endoscopes and intrathecal sodium fluorescein. In a prospective study, twenty-four patients with cerebrospinal fluid rhinorrhea were evaluated and treated by endoscopic endonasal surgery. In all cases intrathecal sodium fluorescein enabled a precise localization of the bone defect. The most common causes of CSF rhinorrhea were traumatic (8 cases, 33 %), spontaneous (6 cases, 25 %), and iatrogenic (5 cases, 20.8 %). Preoperative radiological evaluations (plane CT, CT cisternogram and MRI) showed the exact site and size of the defect in all patients. The most common site of leakage was the ethmoidal roof-cribriform plate. Primary closure was achieved in all patients. There were no major operative or postoperative complications. The endoscopic endonasal approach can be considered the first choice in the treatment of cerebrospinal fluid rhinorrhea.

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Section: Discussionmentioning

confidence: 99%

Endoscopic Endonasal Approach for Cerebrospinal Fluid Fistulae

Silva

Santos

Zymberg

2006

Minim Invasive Neurosurg

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“…There are many facts that may influence the option for a certain graft type: defect size and location, level of intracranial pressure, personal experience and material availability 50 . The techniques of grafting can be divided into: overlay (directly over the defect), underlay (between the dura mater and the bony defect) and combined methods.…”

Section: Treatment Options Of Csf Leaksmentioning

confidence: 99%

Current insights in CSF leaks: a literature review of mechanisms, pathophysiology and treatment options

Patrascu¹,

Manea²,

Sarafoleanu³

2017

Romanian Journal of Rhinology

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A cerebrospinal fluid (CSF) leak occurs when there appears a fistula between the dura and the skull base and it is usually characterized by discharge of cerebrospinal fluid from the nose. Cerebrospinal fluid leaks may have many etiologies, the most common being trauma. The most common site of dural lesion is the cribriform plate of the ethmoid. Diagnosis can be achieved by a multitude of techniques, high-resolution computed tomography being the modality of choice and it may be completed with magnetic resonance imaging or cisternography. Treatment may be either conservative, either surgical, related to the cause, the site and the duration of CSF leak. Conservative treatment usually includes strict bed rest, elevated bed head and no straining, nose blowing or stretching, with resolution of the majority of traumatic CSF leaks in seven days. Surgical treatment consists of a variety of approaches (intracranial/extracranial, open/endoscopic). The future trend is represented by minimally invasive endoscopic approaches, with a success rate of almost 90%; however, open transcranial or extracranial interventions still have indications in the surgical management. CSF leaks must be correctly diagnosed and treated, because the risk of intracranial complications increases 10-fold when the leakage persists.

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“…CSF rhinorrhea can be classified into traumatic (80-90% of cases, including iatrogenic injuries) [1] and non-traumatic (related to brain tumors, infections or skull base congenital defects); [2][3][4][5] spontaneous CSF leakage is also reported (3-4%) [6]. Prompt diagnosis and management are crucial to prevent CNS infections.…”

Section: Introductionmentioning

confidence: 99%