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A Comparative Analysis of Transcranial and Endoscopic Repair for Traumatic CSF Rhinorrhea.

Srivatsan Thirumalai Vasu1, Venkidesh Krishnamoorthy1, Sudish Karunakaran2

  • 1Department of Neurosurgery, Medical Trust Hospital, Cochin, Kerala, India.

Journal of Neurological Surgery. Part A, Central European Neurosurgery
|January 21, 2022
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Summary

Endoscopic endonasal repair for cerebrospinal fluid (CSF) leaks offers lower complication rates and shorter hospital stays compared to transcranial open repair. However, transcranial repair may be preferred for certain frontal sinus leaks.

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Area of Science:

  • Neurosurgery
  • Otolaryngology
  • Trauma Surgery

Background:

  • Anterior cranial base traumatic cerebrospinal fluid (CSF) rhinorrhea presents surgical challenges and complications.
  • Surgeons face a dilemma between open craniotomy and endoscopic endonasal repair for CSF leaks.
  • This study directly compares these two management approaches.

Purpose of the Study:

  • To compare the outcomes of transcranial open repair versus endoscopic endonasal repair for traumatic CSF rhinorrhea.
  • To evaluate recurrence rates, complications, and hospital stay duration for both surgical methods.

Main Methods:

  • A comparative study involving 30 patients with traumatic CSF rhinorrhea.
  • Two groups of 15 patients underwent either transcranial or endoscopic endonasal CSF leak repair over 3 years.
  • Data collected included demographics, recurrence, complications, and hospital/ICU stay, with 6-month follow-up.

Main Results:

  • Recurrence occurred in 9/30 patients (6 transcranial, 3 endoscopic).
  • Complications were significantly higher with transcranial repair (p=0.035), with anosmia being common (33.3%, p=0.042).
  • Endoscopic repair showed reduced ICU stay (p=0.066) and shorter hospitalizations, though not statistically significant (p=0.439).

Conclusions:

  • Transcranial open repair is suitable for frontal sinus leaks extending into the frontoethmoidal region.
  • However, transcranial repair is associated with more complications, higher recurrence, and longer hospital stays.
  • Endoscopic endonasal repair demonstrates a lower morbidity profile but may be less effective for laterally located frontal sinus leaks.