Improved Sinonasal Quality of Life Outcomes Following Endoscopic Endonasal Repair of Spontaneous Cerebrospinal Fluid Leaks

Introduction: Spontaneous cerebrospinal fluid (CSF) rhinorrhea is a rare condition associated with idiopathic intracranial hypertension (IIH). The endoscopic endonasal approach is often utilized for repair of skull base defects in CSF rhinorrhea. However, endoscopic repair can often lead to significant disruption in sinonasal anatomy and physiology. Our objective is to evaluate sinonasal quality of life (QOL) following endoscopic endonasal repair of spontaneous CSF leaks.

Methods: This is a retrospective study of patients with spontaneous CSF leaks who underwent endoscopic endonasal repair from January 2014 to May 2019 at our institution. Patients with complete SNOT-22 data were included. Electronic medical records were reviewed for demographic and operative data. Total and individual item pre- and postoperative (3 and 6 months) SNOT-22 scores were compared using a two-tailed, paired t-test.

Results: Twenty patients with spontaneous CSF leaks were identified as having undergone endoscopic endonasal repair with complete pre- and postoperative SNOT-22 data. Nineteen of the twenty patients were female with a median age of 54 years. Four patients had defects in the cribriform, 5 had defects in the ethmoid roof, 1 had a defect in the frontal, and 10 had defects in the sphenoid [DJM1] . Repair was performed with a free mucosal graft in 14 cases, middle turbinate flap in 2 cases, and a nasoseptal flap in 3 cases. Two patients required revision repair.

The mean preoperative total SNOT-22 score was 33.0 ± 19.8. At 3 and 6 months postoperatively, patients had significant improvement with a mean total score of 15.1 ± 15.1 (p < 0.0002) and 14.2 ± 16.0 (p < 0.006), respectively. Assessment of individual items preoperatively revealed that “runny nose” (mean 3.6 ± 1.6) was the worst symptom, but improved significantly at 3 (0.8 ± 1.0) and 6 months (0.4 ± 0.7). “Wake up at night” (mean 2.6 ± 1.6) was the second worst symptom, but also improved significantly at 3 (0.8 ± 1.1) and 6 months (0.7 ± 1.3). No single item had significantly worse scores postoperatively.

Conclusion: Spontaneous CSF rhinorrhea has a significant impact on QOL, especially as it relates to sinonasal and sleep-related symptoms. Patients undergoing endoscopic endonasal repair of spontaneous CSF leaks exhibited significant improvement in sinonasal QOL at 3 and 6 months postoperatively. SNOT-22 scores reached “normal” levels for these patients.