Cerebrospinal Fluid Rhinorrhea-Clinical Manifestations and Endoscopic Repair

Lee, Chul Hee; Choi, Byung Yoon; Mo, Ji Hun; Lee, Seung Sin; Oh, Seung Jun; Rhee, Chae Seo; Min, Yang Gi

Abstract

BACKGROUND AND OBJECTIVES
Endoscopic technique in intranasal repair of cerebrospinal fluid (CSF) leakage has many advantages over external approaches. This study aimed to review the clinical manifestations of CSF leakage and to investigate the efficacy of the endoscope in the diagnosis and the management of CSF leakage.
SUBJECTS AND METHOD
Twenty-four cases of CSF rhinorrhea were reviewed retrospectively.
RESULTS
Seven out of 22 patients had only rhinorrhea and 14 cases had meningitis. Four cases were successfully managed with conservative management including bed rest and lumbar drains. Intranasal repairs with endoscopes have been applied to 17 cases out of 20 operated cases including 1 case in which both endoscopic repair and craniotomy was used. Endoscopic repairs were not useful in 3 cases in which the operative exposures were insufficient and the leakage sites could not be accessible with endoscope. One case was treated with a craniotomy approach, and in-dwelling shunt operations were required in 2 cases. Leak sites were repaired with free grafts using buccal fat, nasal mucosa, or temporalis muscle and fascia. In some cases, especially when the defect was large, we incorporated bone or cartilage into the grafts. There was no recurrence after the endoscopic closure.
CONCLUSION
Endoscopic approach is safe and effective in managing the CSF rhinorrhea except in cases in which the operative exposure with endoscope is insufficient.