title: Endoscopic Repair of CSF Rhinorrhea: An Institutional Experience.
abstract: BACKGROUND
  Endoscopic repair is considered the treatment of choice in cerebrospinal fluid (CSF) rhinorrhea. The aim of our study was to analyze the etiopathogenesis of CSF rhinorrhea, the outcome of treatment and the causes of failure in a developing-country setting.
  
  
  METHODS
  A retrospective review of patients treated with endoscopic repair for CSF rhinorrhea at a tertiary care hospital in southern India from January 2002 to December 2009 identified 36 patients, the majority of them being women. The defects were closed in three layers using fat, fascia lata and nasal mucosa along with a fibrin sealant in the majority of the patients. Per-operatively, a subarachnoid drain was placed in all patients. Patients were followed up for 1 year.
  
  
  RESULTS
  Spontaneous onset of CSF rhinorrhea was noted in 61% of patients. The most common site of leak was found to be the left cribriform plate area. Hence the most common cause of CSF rhinorrhea in our study was spontaneous and the second most common was post-traumatic. Our success rate on the first attempt at endoscopic repair was 100%, with a recurrence rate of 6%. A large defect, failure of localization of the defect, or other co-morbid conditions such as chronic cough may be the most likely causes of recurrence of leak.
  
  
  CONCLUSIONS
  Accurate localization of the site of lesion using a high-resolution computed tomography (CT) scan with magnetic resonance imaging (MRI) and confirmation of the site of leak by intraoperative Valsalva maneuver along with multilayered closure of the dural defect and post-operative lumbar drain appear to be essential for the successful endoscopic repair of CSF rhinorrhea.
authors.affiliation: Department of Otorhinolaryngology,Indira Gandhi Institute of Medical Sciences, Patna, Bihar, India.
authors.forename: Sarita Kumari
authors.initials: SK
authors.lastname: Mishra
authors.affiliation: Department of Otorhinolaryngology, Christian Medical College, Vellore, Tamilnadu, India.
authors.forename: George Ani
authors.initials: GA
authors.lastname: Mathew
authors.affiliation: Department of Otorhinolaryngology, Christian Medical College, Vellore, Tamilnadu, India.
authors.forename: Roshna Rose
authors.initials: RR
authors.lastname: Paul
authors.affiliation: Department of Otorhinolaryngology, Christian Medical College, Vellore, Tamilnadu, India.
authors.forename: Syed Kamran
authors.initials: SK
authors.lastname: Asif
authors.affiliation: Department of Otorhinolaryngology, Christian Medical College, Vellore, Tamilnadu, India.
authors.forename: Mary
authors.initials: M
authors.lastname: John
authors.affiliation: Department of Otorhinolaryngology, Christian Medical College, Vellore, Tamilnadu, India.
authors.forename: Ajoy Mathew
authors.initials: AM
authors.lastname: Varghese
authors.affiliation: Department of Otorhinolaryngology, Christian Medical College, Vellore, Tamilnadu, India.
authors.forename: Mary
authors.initials: M
authors.lastname: Kurien
keywords: CSF rhinorrhea; Cribriform plate; Subarachnoid Space; Transnasal Endoscopic Surgery; Valsalva Maneuver