Challenges and controversies in endoscopic management of CSF rhinorrhea

Introduction endoscopic management of CSF rhinorrhea is considered by many as the first choice approach because of low morbidity and higher closure rate. However, many challenges and controversies are still reported in the literature.

Objectives to discuss the challenges of repair of CSF leaks through the nose and controversies regarding the use of intraoperative Intrathecal fluorescein (ITF) in localising the defect site and number of graft layers.

Material and Methods the study includes 30 patients who had had endoscopic repair for their CSF rhinorrhea in our institute between July 2015 and June 2017. Fifteen patients (50 %) were managed using two layer repair without ITF injection ( group I ) while the remaining were managed using ITF for localising the defect and three or more graft layers for repair ( Group II). follow up period was 2 years.

Results the study included 30 patients; 17 females (57 %) and 13 males (43 %). Patients age ranged from 4 years to 68 years with mean ± standard deviation = 38 ± 15.86 years. Four cases (13.3 %) had defects in the posterior wall of the frontal sinus while other defects involved the fovea ethmoidalis, lateral lamella and cribriform plate of ethmoid. Success rate was equal in both groups (93 %).

Discussion and conclusion endoscopic management of challenging CSF rhinorrhea in pediatric population and difficult to reach anatomical areas e.g. frontal sinus leaks require good endoscopic visualization and endoscopic instrumentation facilities in addition to experienced surgical hands. Avoidance of ITF and use of double layer repair show the same success rate as the other more time consuming and complication harbouring strategies.

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Artikel online veröffentlicht:
10. Juni 2020