title: Subcranial transnasal repair of cerebrospinal fluid rhinorrhea with free autologous grafts by the combined overlay and underlay techniques.
abstract: OBJECTIVE
  To determine the efficacy of subcranial transnasal repair of cerebrospinal fluid rhinorrhea with free autologous grafts by the combined overlay and underlay techniques using the surgical microscope and/or endoscope.
  
  
  METHODS
  Twenty patients with CSF rhinorrhea were included in this retrospective study. They were 13 males and 7 females. Their age ranged from 7 to 62 years (mean: 39.35). The etiologies of the leak were iatrogenic in 10 cases, spontaneous in 5 cases, traumatic in 4 cases and one case was associated with meningeo-encephalocele. Preoperative nasal endoscopic examination, computed tomography (CT) with intrathecal non-ionic contrast and magnetic resonance imaging (MRI) were done when indicated. Endoscopic and/or microscopic repair of the CSF fistula was done by a combination of both underlay and overlay repair with free autologous grafts as follows: Gelfoam with fibrin glue, strips of fat, facia lata, Gelfoam with fibrin glue (underlay), septal cartilage, Gelfoam with fibrin glue and strips of fat (overlay).
  
  
  RESULTS
  Complete closure of the leak was achieved in all patients. In one case of spontaneous CSF leak which was operated endoscopically, the leak recurred 6 months postoperatively and ceased spontaneously after a month with conservative medical treatment. No major complications were seen and no patients developed meningitis or postoperative anosmia.
  
  
  CONCLUSIONS
  Subcranial transnasal repair with free autologous grafts by the combined overlay and underlay techniques using the endoscope or surgical microscope is a safe and successful method of treating CSF leaks, provided that the CSF leak is precisely located and the site can be reached with the endoscope or surgical microscope.
authors.affiliation: Department of ENT, Faculty of Medicine, El Menoufyia University, El Menoufyia, Egypt. oelbanhawy@ hotmail.com
authors.forename: O A
authors.initials: OA
authors.lastname: El-Banhawy
authors.forename: A N
authors.initials: AN
authors.lastname: Halaka
authors.forename: A
authors.initials: A
authors.lastname: El-Hafiz Shehab El-Dien
authors.forename: H
authors.initials: H
authors.lastname: Ayad
mesh_terms: D000293:Adolescent; D000328:Adult; D002356:Cartilage / Q000637:transplantation*; D002559:Cerebrospinal Fluid Rhinorrhea / Q000601:surgery*; D002648:Child; D004724:Endoscopy / Q000379:methods*; D005206:Fascia Lata / Q000637:transplantation*; D005260:Female; D015718:Fibrin Tissue Adhesive / Q000627:therapeutic use; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008866:Microsurgery / Q000379:methods*; D008875:Middle Aged; D009296:Nasal Cavity / Q000601:surgery*; D019635:Neurosurgical Procedures / Q000379:methods*; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome
chemical_list: D015718:Fibrin Tissue Adhesive