title: Endoscopic repair of cerebrospinal fluid rhinorrhea.
abstract: Endoscopic repair of cerebrospinal fluid rhinorrhea is a promising alternative to traditional repair techniques. This article reports our experience with 21 cases (10 spontaneous, 8 iatrogenic, and 3 traumatic). Various diagnostic radiographic modalities were used, including computer-aided techniques. Most repairs were accomplished with a free fascial graft positioned in the epidural space. Postoperative lumbar drainage was used in 15 cases. Initial repair was successful in 18 cases (85.7%). In all 3 failures, the surgeon had difficulty with proper graft placement. Additionally, 2 of these cases were confounded by early inadvertent removal of the lumbar drain. All patients in whom the procedure failed underwent a second successful endoscopic repair. There were no major complications. In our experience endoscopic repair of cerebrospinal fluid rhinorrhea is a safe and effective approach that can be improved with computer-aided localization devices. Proper graft placement is critical, and lumbar drainage is an important adjunct in selected cases.
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, Thomas Jefferson University Hospital, Philadelphia, USA.
authors.forename: V H
authors.initials: VH
authors.lastname: Mao
authors.forename: W M
authors.initials: WM
authors.lastname: Keane
authors.forename: J P
authors.initials: JP
authors.lastname: Atkins
authors.forename: J R
authors.initials: JR
authors.lastname: Spiegel
authors.forename: T O
authors.initials: TO
authors.lastname: Willcox
authors.forename: M R
authors.initials: MR
authors.lastname: Rosen
authors.forename: D
authors.initials: D
authors.lastname: Andrews
authors.forename: D
authors.initials: D
authors.lastname: Zwillenberg
mesh_terms: D000328:Adult; D000368:Aged; D002559:Cerebrospinal Fluid Rhinorrhea / Q000175:diagnosis / Q000209:etiology / Q000601:surgery*; D004322:Drainage; D004724:Endoscopy; D005205:Fascia / Q000637:transplantation; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011182:Postoperative Care; D012086:Reoperation; D012189:Retrospective Studies; D013813:Therapy, Computer-Assisted