Transnasal Repair of Cerebrospinal Fluid Fistula

Objective: To assess the clinical outcomes of transnasal approach (TNA) for repair of skull base defect.

Methods: A total of 30 patients with CSF rhinorrhea (23 traumatic, 6 iatrogenic, and 1 spontaneous) were treated endoscopically or microscopically. Preoperative radiological evaluations (plane CT, CT cisternogram, and MRI) showed the site and size of the defect in most patients. The most common location of the defect was the sphenoid sinus. The TNA comprising endonasal endoscopic surgery (EES) or transseptospheniodal surgery (TSS) was mainly used for smaller fistulas. The obliteration of the CSF leakage was achieved with a free graft of autologous abdominal fat or temporalis fascia or synthetic collagen graft, and a fibrin glue. Four patients who had extensive bony dural defects with fractures of the anterior cranial base and additional brain injury underwent a transcranial approach (TCA).

Result: CSF rhinorrhea was resolved during the first attempt in 26 of 30 (87%) patients. The four cases showing recurrent CSF leakage after the first intervention were treated successfully by TSS or EES. There were no major perioperative complications. After follow-up (mean, 64 months; range, 1 to 168 months), the overall success rate for 30 CSF fistulas was at 100%.

Conclusion: The TNA via endonasal or transseptal route could be employed as the treatment of choice for the selected patients of CSF fistulas in the anterior and middle fossa, with a high success rate and minimal invasiveness. For extended frontobasal dural lesions, TNA also could be combined with TCA.