Microscopical surgical management of cerebrospinal fluid rhinorrhoea with free grafts

Iatrogenic cerebrospinal fluid (CSF) rhinorrhoea can occur after intranasal ethmoidectomy or removal of pituitary tumours using a transsphenoidal approach, and is categorized as intraoperative or post-operative according to the time of onset. From 1989 to 1992 at Severance Hospital, Seoul, Korea, we successfully repaired nine cases of CSF rhinorrhoea using fibrin-glue-coated fascia or inferior turbinate mucosa under a surgical microscope. Neither recurrent leaks nor post-operative complications were associated with the free graft. Our results indicate that repair of CSF rhinorrhoea using free grafts under a surgical microscope is as successful as using a local flap, and it is a simple and very effective method in managing CSF rhinorrhoea. The surgical technique is discussed in detail.