Transnasal endoscopic repair of anterior skull base fistulas

ABSTRACT

CSF rhinorrhea is the leakage of CSF from the subarachnoid space through the nose. CSF rhinorrhea or liquorrhea commonly occurs following head trauma [frontobasal skull fractures], as a result of intracranial surgery, or destructive lesions, however, CSF rhinorrhea may be spontaneous. The incidence of CSF fistula after ESS is less than 1% yet it represents since recently a common cause of iatrogenic CSF fistula. A spinal fluid leak from the intracranial space to the nasal respiratory tract is potentially very serious because of the risk of an ascending infection which could produce fulminant meningitis, hence the importance of the prompt diagnosis and treatment of such condition. Since the introduction of transnasal endoscopic techniques the morbidity of surgical repair has been significantly reduced when compared with previous intracranial techniques. Is to evaluate the endoscopic endonasal approach in terms of morbidity and efficacy to control CSF fistulas. 43 cases of CSF rhinorrhea operated in the period between 1999 to 2006 are included in this retrospective study. Patients' data preoperatively as regarding history, examination and investigations, as well as operative details and postoperative care and outcome are carefully reviewed, analyzed and compared to the literature. Endoscopic transnasal repair of CSF fistulas in our study had an excellent outcome with a success rate of 95% in the first attempt and reaching up to 100% in the second attempt without any significant postoperative complication. Our leak sites were mainly found in the ethmoidal region [in 67.4%]. The endoscopic repair of CSF Rhinorrhea provides a safe and efficient technique for closure of the anterior and middle skull base sinonasal defects with minimal morbidity and hospital stay