Abstract | OBJECTIVE: To determine the efficacy of subcranial transnasal repair of cerebrospinal fluid rhinorrhea with free autologous grafts by the combined overlay and underlay techniques using the surgical microscope and/or endoscope. PATIENTS AND METHODS: Twenty patients with CSF rhinorrhea were included in this retrospective study. They were 13 males and 7 females. Their age ranged from 7 to 62 years (mean: 39.35). The etiologies of the leak were iatrogenic in 10 cases, spontaneous in 5 cases, traumatic in 4 cases and one case was associated with meningeo- encephalocele. Preoperative nasal endoscopic examination, computed tomography (CT) with intrathecal non-ionic contrast and magnetic resonance imaging (MRI) were done when indicated. Endoscopic and/or microscopic repair of the CSF fistula was done by a combination of both underlay and overlay repair with free autologous grafts as follows: Gelfoam with fibrin glue, strips of fat, facia lata, Gelfoam with fibrin glue (underlay), septal cartilage, Gelfoam with fibrin glue and strips of fat (overlay). RESULTS: Complete closure of the leak was achieved in all patients. In one case of spontaneous CSF leak which was operated endoscopically, the leak recurred 6 months postoperatively and ceased spontaneously after a month with conservative medical treatment. No major complications were seen and no patients developed meningitis or postoperative anosmia. CONCLUSION: Subcranial transnasal repair with free autologous grafts by the combined overlay and underlay techniques using the endoscope or surgical microscope is a safe and successful method of treating CSF leaks, provided that the CSF leak is precisely located and the site can be reached with the endoscope or surgical microscope.
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Authors | O A El-Banhawy, A N Halaka, A El-Hafiz Shehab El-Dien, H Ayad |
Journal | Minimally invasive neurosurgery : MIN
(Minim Invasive Neurosurg)
Vol. 47
Issue 4
Pg. 197-202
(Aug 2004)
ISSN: 0946-7211 [Print] Germany |
PMID | 15346314
(Publication Type: Journal Article)
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Chemical References |
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Topics |
- Adolescent
- Adult
- Cartilage
(transplantation)
- Cerebrospinal Fluid Rhinorrhea
(surgery)
- Child
- Endoscopy
(methods)
- Fascia Lata
(transplantation)
- Female
- Fibrin Tissue Adhesive
(therapeutic use)
- Humans
- Magnetic Resonance Imaging
- Male
- Microsurgery
(methods)
- Middle Aged
- Nasal Cavity
(surgery)
- Neurosurgical Procedures
(methods)
- Retrospective Studies
- Tomography, X-Ray Computed
- Treatment Outcome
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