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J Neurol Surg B Skull Base 2013; 74(02): 061-067
DOI: 10.1055/s-0033-1333620
Original Article
Georg Thieme Verlag KG Stuttgart · New York

Endoscopic Management of Cerebrospinal Fluid Rhinorrhea: The Charing Cross Experience

Jagdeep Singh Virk
1   Department of ENT, Charing Cross Hospital, Imperial College Healthcare, London, United Kingdom
,
Behrad Elmiyeh
1   Department of ENT, Charing Cross Hospital, Imperial College Healthcare, London, United Kingdom
,
Hesham A. Saleh
1   Department of ENT, Charing Cross Hospital, Imperial College Healthcare, London, United Kingdom
› Author Affiliations
Further Information

Publication History

03 August 2012

20 October 2012

Publication Date:
13 February 2013 (online)

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Abstract

Objective To describe our experience of cerebrospinal fluid (CSF) rhinorrhea management.

Design Retrospective.

Setting Charing Cross Hospital, London, a tertiary referral center.

Participants Fifty-four patients with CSF rhinorrhea managed from 2003 to 2011.

Main outcome measures Surgical technique; Recurrence.

Results Etiologically, 36 were spontaneous and 18 traumatic. Eight patients with spontaneous and two with traumatic leaks had previous failed repairs in other units. Success rates after first and second surgery were 93% and 100%, respectively. Mean follow-up was 21 months. Four patients, all of spontaneous etiology, had recurrences; three of these underwent successful second repair with three layered technique, and the fourth had complete cessation of the leak after gastric bypass surgery and subsequent weight reduction. Adaptation of anatomic three-layered repair since then averted any further failure in the following 7 years. Mean body mass index was 34.0 kg/m2 in spontaneous and 27.8 kg/m2 in traumatic cases (p < 0.05). Fifty percent of spontaneous leaks were from the cribriform plate, 22% sphenoid, 14% ethmoid, and 14% frontal sinus. In the traumatic CSF leak group: 33.3% were from the cribriform plate, 33.3% sphenoid, 22.2% ethmoid, and 11.1% frontal.

Conclusion Endoscopic CSF fistula closure is a safe and effective operation. All sites of leak can be accessed endoscopically. We recommend the use of an anatomic three-layered closure in difficult cases.

Keywords

cerebrospinal fluid - rhinorrhea - endoscopic - skull base - spontaneous leaks

Notes

6th International Congress of the World Federation of Skull Base Societies & 10th European Skull Base Society Congress, Brighton, UK. Wednesday 16 May 2012.


6th Australian Rhinology Society Conference, Coolum, QLD, Australia. Sunday 7 October 2012.


 

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