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Published on: February 29, 2020
Endoscopic transnasal cerebrospinal fluid leak repair: a 10 year experience
Hanna Gilat1, Zvi Rappaport, Eitan Yaniv
1Department of Otorhinolaryngology-Head and Neck Surgery, Nose and Sinus Institute, Rabin Medical Center (Beilinson Campus), Petah Tikva, Israel.
Background:
Endoscopic techniques have gained popularity for the repair of anterior skull base defects.
Objective:
To describe the 10 year experience with endoscopic surgical repair of cerebrospinal fluid (CSF) rhinorrhea in a tertiary medical center.
Methods:
The files of all patients who underwent endoscopic transnasal CSF leak repair in our institution between 1996 and 2006 were reviewed.
Results:
Twenty-four patients were identified: 16 women and 7 men with a mean age of 48 years and one child aged 9.5 years. The leak was trauma-induced in 17 patients and occurred spontaneously in the other 7. The defect was localized by preoperative computed tomography or CT/cysternography in 86% of cases. A fascia lata graft was the dominant choice for defect closure, and it was combined with a conchal or septal flap, fat, periosteum, or fibrin glue in 15 patients. The success rate was 83% after the first closure attempt and 91% after the second. Two patients required a craniotomy at the third attempt. Mean hospitalization time was 6.7 days. There were two minor complications. Two patients were lost to follow-up; none of the others had a recurrence during 2 years of follow-up.
Conclusions:
The endoscopic transnasal technique for the repair of CSF rhinorrhea is associated with a high success rate and low morbidity, and it should be considered for the majority of cases. Repeated attempts may improve success.
