Transnasal Repair of Traumatic Cerebrospinal Fluid Rhinorrhea

ABSTRACT

OBJECTIVE: This study is aimed to evaluate the efficacy of transnasal repair of cerebrospinal fluid(CSF) rhinorrhea. METHODS: Thirteen patients with traumatic noniatrogenic CSF fistulas were included in the retrospective analysis. High-resolution thin-section computed tomographic cisternography was helpful in localization of the CSF leakage site. The most frequent leakage site was the sphenoid sinus. The transnasal approach(TNA), comprised of endonasal endoscopic surgery(EES) or transseptosphenoidal surgery(TSS), was mainly used for smaller fistulas. Total or selected ethmoidectomy depended on the localization of the leakage. Wide sphenoidotomy enabled detection and repair of CSF leaks from the sphenoid cavity. Three patients also underwent transcranial approach(TCA) because of the large or multi-fragmented bony defect and the need for further exposure for repair. Five patients developed ascending meningitis in the preoperative period with antibiotic prophylaxis. RESULTS: Twenty-five leaks were initially repaired using one of three techniques:EES alone in eight patients, EES plus TCA in three, and TSS alone in two. Ten patients who solely underwent the TNA did not experience the complications of the traditional TCA. One recurrent sphenoid fistula was successfully treated by TSS. After a follow-up from 12 to 88 months(mean 32.7), the overall success rate for 25 CSF fistulas was 100%. CONCLUSION: The transnasal repair is a safe, successful, and alternative approach for the surgical repair of traumatic CSF rhinorrhea, and also could be combined to TCA.