title: Cerebrospinal fluid rhinorrhea: An institutional perspective from Pakistan.
abstract: BACKGROUND
  The management of cerebrospinal fluid (CSF) rhinorrhea has evolved over the last two decades. We present here a review of our 11-year data on CSF rhinorrhea and its management at a tertiary care hospital in a developing country, with particular reference to the diagnosis, surgical management and outcome of the disease.
  
  
  METHODS
  The medical charts of all patients with a diagnosis of CSF rhinorrhea over an 11-year period were reviewed. The etiology of CSF rhinorrhea was classified into three categories: spontaneous, iatrogenic and traumatic. All the patients were divided into three categories based on the type of management as conservative, intracranial and transnasal endoscopic groups.
  
  
  RESULTS
  A total of 43 patients fulfilled our inclusion criteria and were included in the final analysis. Eleven of the 43 patients were managed conservatively, while 22 underwent intracranial repairs; 10 patients had transnasal endoscopic repairs. The primary success rate for the transnasal approach was 70% compared to 86% for the intracranial repair. Blood loss, special care unit (SCU) stay and total cost were found to be significantly less in the transnasal endoscopic group. Computed tomography (CT) cisternography was found to have the highest sensitivity and specificity. Further, no postoperative complications were found in the transnasal endoscopic group, while five patients from the intracranial group developed various complications.
  
  
  CONCLUSIONS
  We conclude that the transnasal endoscopic approach has comparable success rates with the intracranial approach and significantly lower morbidity.
authors.affiliation: Department of Neurosurgery, Aga Khan University, Pakistan.
authors.forename: Muhammad Zubair
authors.initials: MZ
authors.lastname: Tahir
authors.forename: Muhammad Babar
authors.initials: MB
authors.lastname: Khan
authors.forename: Muhammad Umair
authors.initials: MU
authors.lastname: Bashir
authors.forename: Shabbir
authors.initials: S
authors.lastname: Akhtar
authors.forename: Ehsan
authors.initials: E
authors.lastname: Bari