[Surgical management of cerebrospinal fluid rhinorrhea]

To summarize the clinical experience in managing cerebrospinal fluid (CSF) rhinorrhea. To ascertain the best effective surgical management for CSF rhinorrhea.

A retrospective study of 83 patients with CSF rhinorrhea from March 1991 to August 2001 was conducted. Among them, 17 patients were treated with conservative therapy, 8 with transcranial repair, 2 with extranasal repair, 3 with transnasal repair under microscope and 54 with transnasal endoscopic management. The conservative time, causes, complications, leak sites, repairing materials and surgical methods were analysed.

All patients were followed -up for 6 months to 9 years. 17 cases had no CSF rhinorrhea after conservative treatment with an average time 16 days. Endoscopic repair of CSF leaks was successful in 90% (49/54) of the cases after a first attempt. Two persistent leaks (2/4) were closed after a second attempt. The other persistent leaks were also closed, one case after third and one after fourth attempt. Ultimately 98% (53/54) of the leaks were repaired using an endoscopic approach. Only one failed after transendoscopic management, and succeeded with a second extranasal repair. The CSF rhinorrhea repaired with other surgical methods were all successful.

Transnasal endoscopic management is the best method for repairing CSF rhinorrhea, other surgical methods can be chosen based on different conditions. The conservative time are 2 to 4 weeks if a CSF leak is caused by trauma or operation, 6 to 8 weeks conservative time for special cases.