Surgical strategy for cerebrospinal fluid rhinorrhea repair.
OBJECTIVE
Cerebrospinal fluid (CSF) rhinorrhea is leakage of CSF from the nasal cavity caused by cranial base or meningeal defects. Surgical treatment of CSF rhinorrhea is still problematic. We evaluated the clinical outcomes of 132 consecutive cases of CSF rhinorrhea treated via transcranial or transnasal endoscopic approaches according to the patient's condition. The indications for the approaches are discussed.


METHODS
Of 132 patients with CSF rhinorrhea, a transnasal endoscopic approach was used in 98 to repair cranial base defects in the ethmoid and sphenoid sinuses. A transcranial intradural approach was used in the remaining 34 patients for frontal sinus defects, multiple fractures of the cranial base, or combination nerve injury.


RESULTS
CSF rhinorrhea resolved after initial surgery in 124 of 132 patients, giving a success rate of 94%. Of the 8 failures or recurrent cases, 4 were successfully repaired by repeat endoscopic surgery, 2 were cured by transcranial revision surgery, and 2 refused additional surgery (the condition subsequently resolved without treatment in these patients). Postoperative complications included intracranial infection (8 patients) and anosmia (1 patient). No neurological deficits were apparent over the 10-month mean follow-up period.


CONCLUSIONS
Transnasal endoscopic repair is a reliable method for CSF rhinorrhea patients whose fistulae are located in the ethmoid and sphenoid sinuses. The transcranial procedure should be the treatment of choice for patients with frontal sinus fracture, multiple or complex anterior cranial base fractures, or nerve injury. A satisfactory surgical outcome depends on exact diagnosis, proper operative approach, and the surgeon's skill and experience.
Liu
Pinan
P
Department of Neurosurgery, Beijing Tiantan Hospital of Capital Medical University, Beijing, People's Republic of China. pinanliu@yahoo.com.cn
Wu
Shengtian
S
Li
Zhi
Z
Wang
Bo
B
D000293:Adolescent; D000328:Adult; D000368:Aged; D002559:Cerebrospinal Fluid Rhinorrhea / Q000473:pathology / Q000601:surgery*; D002648:Child; D002675:Child, Preschool; D003399:Craniotomy / Q000379:methods* / Q000592:standards; D004724:Endoscopy / Q000379:methods* / Q000592:standards; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D008875:Middle Aged; D009296:Nasal Cavity / Q000033:anatomy & histology / Q000601:surgery*; D019635:Neurosurgical Procedures / Q000295:instrumentation / Q000379:methods*; D010254:Paranasal Sinus Diseases / Q000473:pathology / Q000601:surgery; D012189:Retrospective Studies; D019291:Skull Base / Q000473:pathology / Q000601:surgery*; D020205:Skull Fracture, Basilar / Q000473:pathology / Q000601:surgery; D055815:Young Adult