ABSTRACT
Background: Cerebrospinal fluid (CSF) rhinorrhea is the result of an osseous defect in the skull base coupled with a disruption of duramater and arachnoid mater with a resultant pressure gradient, leading to CSF leak. CSF leak can be categorized into spontaneous(idiopathic), traumatic, and non-traumatic. Endoscopic transnasal approach is an extracranial approach which has the advantage ofbeing less invasive, no external scar, excellent site localization with preservation of the surrounding anatomy, and shorter hospital stay.Aim of the Study: The aim of the study was to assess the outcome of repair, cause, site of leak, and efficacy of materials usedfor the repair, elucidate the advantages of endoscopic approach.Materials and Methods: A total of 25 patients with CSF rhinorrhea arising from anterior and middle cranial fossa not subsidingwith medical management were included in this prospective study. Patients of all ages and gender were included in the study.Patients with recent history of meningitis were excluded from the study. All the patients were evaluated for CSF rhinorrhea usingbattery of tests including clinical examination for reservoir sign, biochemical and microbiological analysis of fluid, radiologicalinvestigations, and diagnostic nasal endoscopy to assess the site of leak. The demographic data, CSF leak site and size, etiology,complications, surgical closure techniques, complications of surgery, and recurrences and its management were observed andrecorded. All the data were analyzed using standard statistical methods.Observation and Results: Among the 25 patients, 14/25 (56%) patients were aged below 30 years followed by 11/25 (44%)patients who were aged between 30 and 60 years. The mean age was 34.20 ± 2.35 years. 16/25 (64%) patients were (64%)female and 9/25 (36%) patients were male. 22/25 patients (88%) had spontaneous leaks and 3 patients (12%) had traumaticleaks. In 18/25 (72%) of the patients, the site of leak was in the cribriform plate, 4/25 (16%) from fovea ethmoidalis, 2/25(8%)from the sphenoid, and 1/25 (4%) from the frontal sinus. Immediate post-operative results were observed in 23/25 (92%) of thepatients and there was no CSF leak. 2/25 (8%) patients had CSF leak for 10 days which later subsided.Conclusions: The most common etiology of CSF rhinorrhea was spontaneous, most common site being the cribriform plate.Autologous fat graft was used as the first layer of underlay technique in most of the cases which act as a good sealant. The efficacyof transnasal endoscopic CSF leak repair in our study was found to be 100%, and it is a highly successful and safe procedure.