Endoscopic repair of cerebrospinal fluid leaks after neurosurgical procedures.
OBJECTIVE
Endoscopic repair of cerebrospinal fluid (CSF) leaks has proven to be effective and safe. CSF rhinorrhea is a well-known complication of neurosurgical procedures in the anterior cranial fossa. We present a series of endoscopic repairs of CSF rhinorrhea secondary to neurosurgical procedures.


METHODS
Retrospective review of 13 cases.


METHODS
Thirteen patients are included in the study. Eleven had CSF leaks after hypophysectomy, one after clipping of an anterior circle of Willis aneurysm, and one after posttraumatic frontal lobe debridement. Leaks were identified intraoperatively during the neurosurgical procedure (n = 8) or with intrathecal fluorescein injection during a separate procedure (n = 5). Repair was performed by exposing the skull base defect, debriding the defect margins, and sealing the defect with a free mucosal graft or abdominal fat.


RESULTS
Leaks were identified in the sphenoid (n = 12) and posterior ethmoid (n = 1) sinuses. Nine patients had lumbar drains placed. One patient had recurrence of CSF rhinorrhea 2 months after initial repair requiring a revision procedure. No other recurrences were noted. One patient developed postoperative meningitis requiring intravenous antibiotics and a prolonged hospital stay. No other postoperative complications were observed.


CONCLUSIONS
Endoscopic repair is a safe and effective treatment for CSF rhinorrhea encountered as a neurosurgical complication.
White
David R
DR
Department of Otolaryngology-Head and Neck Surgery, University of North Carolina Hospitals, Chapel Hill 27599-7070, USA. david_white@med.unc.edu
Dubin
Marc G
MG
Senior
Brent A
BA
D000293:Adolescent; D000328:Adult; D000368:Aged; D001921:Brain / Q000601:surgery*; D002559:Cerebrospinal Fluid Rhinorrhea / Q000209:etiology / Q000601:surgery*; D002648:Child; D003646:Debridement; D006801:Humans; D007016:Hypophysectomy; D008297:Male; D008875:Middle Aged; D044583:Neuroendoscopy / Q000379:methods*; D011183:Postoperative Complications; D012086:Reoperation; D012189:Retrospective Studies; D016896:Treatment Outcome