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Extracranial repair of pediatric traumatic cerebrospinal fluid rhinorrhea
1Department of Otolaryngology--Head and Neck Surgery, Children's Hospital of Los Angeles and the University of Southern California School of Medicine, USA. mng@welchlink.welch.jhu.edu
Insights
Extracranial repair of traumatic cerebrospinal fluid (CSF) leaks in children is effective. This minimally invasive approach successfully treated 3 of 4 pediatric patients, avoiding complications associated with traditional intracranial methods.
Area of Science:
- Neurosurgery
- Pediatric Otolaryngology
- Skull Base Surgery
Background:
- Persistent cerebrospinal fluid (CSF) rhinorrhea in pediatric patients often results from traumatic defects in the cribriform plate and ethmoid roof.
- Traditional intracranial approaches for repair carry risks and complications.
- Evaluating alternative, less invasive surgical methods is crucial for pediatric skull base defects.
Observation:
- A retrospective case series examined four pediatric patients with traumatic cribriform plate or ethmoid roof defects causing CSF rhinorrhea.
- Patients underwent transnasal endoscopic repair, with two also requiring external ethmoidectomy for enhanced exposure.
- Outcomes assessed included freedom from CSF leaks, recurrence, meningitis, and other postoperative complications.
Findings:
- The extracranial approach was successful in 3 of 4 pediatric patients, with no reported CSF leaks, meningitis, or other complications.
- Patients treated solely with the extracranial method avoided the complications associated with traditional intracranial surgery.
- One patient experienced a recurrence, highlighting the need for careful patient selection.
Implications:
- The extracranial approach is a viable and potentially safer alternative for select pediatric patients with traumatic CSF leaks.
- This method may reduce morbidity in pediatric skull base surgery.
- Further research with larger cohorts is warranted to confirm the long-term efficacy and safety of extracranial CSF leak repair.
Objective:
To examine the methods of extracranial repair of traumatic defects in the cribriform plate and ethmoid roof resulting in persistent cerebrospinal fluid (CSF) rhinorrhea in pediatric patients.
Design:
Retrospective case series.
Setting:
A single-institution, tertiary care, pediatric hospital.
Patients:
Four children, ranging in age from 3 1/2 to 9 years, who sustained fractures in the cribriform plate or ethmoid roof.
Intervention:
Transnasal endoscopic repair in 4 patients, with 2 patients also undergoing external ethmoidectomy because of the large bony defect and the need for further exposure for repair.
Main Outcome Measures:
Time free from CSF leaks or recurrence, meningitis, and other postoperative complications.
Results:
All patients except 1 have been free of recurrent CSF leaks, meningitis, and other postoperative complications. The 3 patients who solely underwent the extracranial approach did not experience the complications of the traditional intracranial approach.
Conclusions:
In a select group of pediatric patients, the extracranial approach for the repair of CSF leaks is appropriate. Successful use of an extracranial approach in 3 of 4 patients supports this method.