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Cranionasal fistula in pediatric population: is endonasal endoscopic approach effective?
Ashok K Gupta1, Anish K Gupta, Mayuresh Verma
1Department of Otolaryngology, Head & Neck Surgery, PGIMER, Chandigarh, India. akgpgi@yahoo.com
Insights
Endoscopic endonasal repair effectively treats cerebrospinal fluid (CSF) leaks in children, showing a 96% success rate. This minimally invasive technique is safe and superior to traditional craniotomy for pediatric CSF rhinorrhea.
Area of Science:
- Neurosurgery
- Otolaryngology
- Pediatric Surgery
Background:
- Cerebrospinal fluid (CSF) rhinorrhea in children is a rare condition.
- Previous management strategies often involved open craniotomy.
- Limited large-scale studies exist on endoscopic repair for pediatric CSF leaks.
Purpose of the Study:
- To evaluate the efficacy and safety of endoscopic endonasal repair for CSF leaks in pediatric patients.
- To establish endoscopic repair as a viable treatment option for pediatric CSF rhinorrhea.
Main Methods:
- Prospective study conducted at a tertiary care center.
- Included pediatric patients (<14 years) diagnosed with CSF rhinorrhea.
- Utilized detailed examination, CT cisternography, and MRI for diagnosis.
- Performed endoscopic endonasal fistula repair.
Main Results:
- 25 pediatric cases were analyzed, with a male predominance.
- Trauma was the cause in 22 cases; spontaneous leaks in 3.
- Most leaks originated from the cribriform plate area.
- Successful repair achieved in 24 cases (96%); one recurrence managed with a second surgery.
Conclusions:
- Endoscopic endonasal repair demonstrates high success (96%) and safety in pediatric CSF leak cases.
- This approach offers significantly lower morbidity and mortality compared to craniotomy.
- Endoscopic closure is recommended as the standard of care for pediatric cranio-nasal fistulas.
Purpose:
To study the efficacy and safety of endoscopic endonasal repair of CSF leak in pediatric population.
Study Design:
A prospective study in a tertiary care center.
Patients And Methods:
All the cases with a age of less than 14 years with a diagnosis of CSF rhinorrhoea were included in the study. These were subjected to detailed examination, radiological evaluation using computed tomographic cisternography and MRI if required. These cases were then subjected to endoscopic endonasal repair of the fistula using the technique described in the text.
Results:
There were 25 cases in the study with a male predominance and trauma responsible for 22 of these and spontaneous leak in 3 of the cases. The majority of these leaks were from cribriform plate area. After the repair, there was no leak in 24 of these cases and 1 case with recurrence did well after second surgery.
Discussion:
The prior work on the entity of CSF rhinorrhoea in children consists of a few case reports only and ours is the largest series on endoscopic repair of the CSF leak in children showing it to be safe and effective with a success rate of 96%.
Conclusion:
Endoscopic closure of the cranio nasal fistula is associated with a high degree of success (96% in our series) and has significantly less morbidity and mortality when compared with the craniotomy approach. Hence it can be concluded that it is the standard of care for the pediatric population as well.
