title: Evolution of the extracranial approach for repair of CSF leaks: review of the literature and clinical cases.
abstract: The management of cerebrospinal fluid rhinorrhea changed with the advent of endoscopes in the early 1990s. The majority of repairs are now approached endoscopically, i.e., extracranially. This article reviews the evolution of the extracranial approach, as reported in the literature, concluding with the experience of the authors. A total of 15 patients were treated by the primary author since 1987; an open external ethmoid approach was utilized in 3 patients, and an endoscopic approach was used to treat 12 patients. The success rate with the external ethmoid approach was 100%; with the endoscopic approach, the primary success rate was 75% (9/12). There were 3 failures: One was due to a graft shrinkage; another was secondary to inadequate visibility; and the reason for the third was unclear. Eventually, all three were successfully repaired. Based on this experience, cerebrospinal fluid rhinorrhea can be successfully managed via an extracranial approach 75% of the time.
authors.affiliation: Division of Otolaryngology, Department of Surgery, University of South Florida, College of Medicine, 4 Columbia Drive, Suite 730, Tampa, FL 33606, USA. dklotch@ix.netcom.com
authors.forename: D W
authors.initials: DW
authors.lastname: Klotch
authors.forename: N
authors.initials: N
authors.lastname: Patel
authors.forename: E
authors.initials: E
authors.lastname: Dussia
mesh_terms: D002356:Cartilage / Q000637:transplantation; D002559:Cerebrospinal Fluid Rhinorrhea / Q000175:diagnosis / Q000601:surgery*; D004724:Endoscopy / Q000379:methods*; D005005:Ethmoid Sinus / Q000601:surgery; D005205:Fascia / Q000637:transplantation; D015718:Fibrin Tissue Adhesive / Q000627:therapeutic use; D019793:Fluorescein; D005500:Follow-Up Studies; D006801:Humans; D007202:Indicators and Reagents; D009092:Mucous Membrane / Q000637:transplantation; D012189:Retrospective Studies; D014014:Tissue Adhesives / Q000627:therapeutic use; D016896:Treatment Outcome
chemical_list: D015718:Fibrin Tissue Adhesive; D007202:Indicators and Reagents; D014014:Tissue Adhesives; D019793:Fluorescein