title: Determining leak locations during transnasal endoscopic repair of cerebrospinal fluid rhinorrhea.
abstract: OBJECTIVE
  For transnasal endoscopic repair procedures to be successful, it is critical to identify leak locations during surgery. We aim to evaluate different methods to more accurately detect leak locations during the endoscopic repair of cerebrospinal fluid rhinorrhea.
  
  
  METHODS
  We performed a retrospective chart review of 39 cases undergoing endoscopic repair of cerebrospinal fluid rhinorrhea. The leak locations were determined using preoperative nasal endoscopy, radioisotope scanning, the intraoperative image-guided system, and intraspinal normal saline injection.
  
  
  RESULTS
  The cerebrospinal fluid leak location was in the sphenoidal sinus in 9 cases, the ethmoid sinus in 17 cases, and in the frontal sinus in 1 case. The leak locations could not be determined in the remaining 12 cases using this method alone. For these 12 cases, after the ethmoid sinus was opened and the lateral wall of sphenoidal sinus was exposed with the aid of the intraoperative image-guided system, outflow of cerebrospinal fluid was present on the lateral wall of sphenoidal sinus (in 1 case) and on the ethmoid roof (in 3 cases). Furthermore, using intraspinal saline injection (20-30 ml), leak locations were detected in the sphenoidal sinus (2 cases) and in ethmoid sinus (6 cases) of the remaining cases.
  
  
  CONCLUSIONS
  For cerebrospinal fluid rhinorrhea patients whose leak locations are difficult to determine, surgeons can increase their operative success rates by performing radioisotope scanning and intraspinal saline injections and by using image-guided surgical systems. These safe and effective methods can be used to successfully detect leak locations during transnasal endoscopic repair of cerebrospinal fluid leaks.
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, Xijing Hospital, Fourth Military Medical University, No. 15 Changle Western Road, Xi'an, China.
authors.forename: Li
authors.initials: L
authors.lastname: Qiao
authors.forename: Tao
authors.initials: T
authors.lastname: Xue
authors.forename: Ding-jun
authors.initials: DJ
authors.lastname: Zha
authors.forename: Fu-quan
authors.initials: FQ
authors.lastname: Chen
authors.forename: Xu
authors.initials: X
authors.lastname: Li
authors.forename: Jian-hua
authors.initials: JH
authors.lastname: Qiu
authors.forename: Zhao-hui
authors.initials: ZH
authors.lastname: Shi
authors.forename: Li-ting
authors.initials: LT
authors.lastname: Wen
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002559:Cerebrospinal Fluid Rhinorrhea / Q000175:diagnosis* / Q000601:surgery*; D002648:Child; D004724:Endoscopy; D005005:Ethmoid Sinus / Q000473:pathology / Q000601:surgery; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D038361:Neuronavigation; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D012965:Sodium Chloride; D013101:Sphenoid Sinus / Q000473:pathology / Q000601:surgery; D016284:Technetium Tc 99m Pentetate; D055815:Young Adult
chemical_list: D012965:Sodium Chloride; D016284:Technetium Tc 99m Pentetate