[Intranasal microsurgery in treatment of cerebrospinal rhinorrhea]

The authors describe two female patients with CSF-leakage. The first patient showed spontaneous CSF rhinorrhea from a leak in the posterior wall of the sphenoid sinus and the second one showed a traumatic fistula in "lamina cribrosa" area. The treatment of choice is closure of the CSF leakage by nasal surgeon (intranasal and with help of binocular microscope under hypotensive anaesthesia) using either intranasal-transseptal or intranasal-transethmoidal approach). This preserves olfaction and avoids the risk of a neurosurgical or paranasal methods. The diagnosis of CSF rhinorrhea can be established by beta-2 transferrin test, isotope scanning or fluorescence endoscopy. The high-resolutions CT is the best method for localization of the bone defect. The intranasal interposition of fascial or conchal grafts with use of fibrigen glue in cases of small defect (< 1-2 cm) is always successful.