Trans-Nasal Endoscopic Repair of CSF Rhinorrhea: An Institutional Experience

Muhammad Arshad; Malik Jawad Faisal; Ahmed Hasan Ashfaq; Nida Riaz; Shahzaib Maqbool

doi:10.1007/s12070-023-04267-2

Trans-Nasal Endoscopic Repair of CSF Rhinorrhea: An Institutional Experience

Indian J Otolaryngol Head Neck Surg. 2024 Feb;76(1):748-752. doi: 10.1007/s12070-023-04267-2. Epub 2023 Oct 13.

Authors

Muhammad Arshad¹, Malik Jawad Faisal², Ahmed Hasan Ashfaq¹, Nida Riaz¹, Shahzaib Maqbool¹

Affiliations

¹ Department of otorhinolaryngology and head and neck surgery, Benazir Bhutto Hospital, Rawalpindi, Pakistan.
² Department of ENT, Pakistan institute of medical sciences (PIMS), Islamabad, Pakistan.

PMID: 38440577
PMCID: PMC10908915 (available on 2025-02-01)
DOI: 10.1007/s12070-023-04267-2

Abstract

Introduction: Cerebrospinal Fluid (CSF) rhinorrhea results from breakdown in the integrity of structures separating the subarachnoid space and nasal cavity, namely subarachnoid space and dura mater, the bony skull base and periostea alongside the upper aerodigestive tract mucosa. Endoscopic repair is considered the treatment of choice for CSF rhinorrhea. Our aim of study was to analyze the etiopathogenesis and outcomes of treatment.

Material and methods: A retrospective study review of patients treated with endoscopic repair of CSF rhinorrhea at tertiary care hospital in ENT Department Benazir Bhutto hospital Rawalpindi from august 2013 to September 2017 identified 25 patients. Majority of them were male. The defects were closed in three layers using fat, fascia lata and nasal mucosa along with fibrin sealant in majority of patients. Pre operatively subarachnoid drain was placed in all patients. Patients were followed up to 3 months.

Results: Forty-four patients underwent endoscopic repair of CSF rhinorrhea. The age group ranged from 16 to 55 years. Of the total of 44 patients 26 (59%) were males and 18(41%) females. The mean age of the patients in our study was 32.8 ± 9.7. Post trauma CSF leak was seen up to 52.3% of the patients. The most common site of leakage was identified Cribriform plate area. Our success rate of endoscopic repair was 88.6%. The most commonly observed complication was meningitis that was observed in 2 (4.5%) of the patients that too were managed conservatively.

Conclusion: Accurate localization of site of leakage appears to be essential for successful endoscopic repair of CSF rhinorrhea. In our study cribriform plate area was commonly observed area of CSF leak. In our study, the success rate was 88.6% and low complication rate 4.5%.

Keywords: CSF rhinorrhea; Dural defect; Trans-nasal Endoscopic repair.

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