[Endoscopic diagnosis and treatment of nasal rhinorrhea]

43 patients with nasal liquorrhea (NL) were admitted to and operated on using endonasal endoscopic technique in N. N. Burdenko Research Institute of Neurosurgery from 1999 to 2002. The diagnostic examination included nasal cavity endoscopy, biochemistry of glucose in nasal discharge. CT and MRT-cysternography, plain CT and MRT of the brain. By etiology, liquor fistulas were divided into spontaneous (n = 21), posttraumatic (n = 6) and iatrogenic (n = 16). The source of liquorrhea located in the sphenoidal sinus (n = 20), roof of the ethmoidal labyrinth (n = 10), cribriform plate (n = 12). A total of 47 operations and 4 reoperations were made with application of the biological fibrin-thrombin glue tissucol. The maximal size of the defect in the base of the skull in this series reached 15 mm. Lumbar drainage, removed on postoperative day 5, on the average, was established during endoscopic endonasal plastic repair of the liquor fistula in 34 patients. In maximal follow-up of 3.5 years, a complete recovery was observed in 38 (88.4%) operated on patients. The main causes of unsatisfactory effectiveness of endonasal operations were the following: impossible visualization of the fistula in a deep lateral pocket of the sphenoidal sinus, compound pathology (nasal liquorrhea and tumor of the base of the skull), extensive multiple traumas of the bone structures of the base of the skull.