Abstract
Objective To describe our experience of cerebrospinal fluid (CSF) rhinorrhea management.
Design Retrospective.
Setting Charing Cross Hospital, London, a tertiary referral center.
Participants Fifty-four patients with CSF rhinorrhea managed from 2003 to 2011.
Main outcome measures Surgical technique; Recurrence.
Results Etiologically, 36 were spontaneous and 18 traumatic. Eight patients with spontaneous
and two with traumatic leaks had previous failed repairs in other units. Success rates
after first and second surgery were 93% and 100%, respectively. Mean follow-up was
21 months. Four patients, all of spontaneous etiology, had recurrences; three of these
underwent successful second repair with three layered technique, and the fourth had
complete cessation of the leak after gastric bypass surgery and subsequent weight
reduction. Adaptation of anatomic three-layered repair since then averted any further
failure in the following 7 years. Mean body mass index was 34.0 kg/m2 in spontaneous and 27.8 kg/m2 in traumatic cases (p < 0.05). Fifty percent of spontaneous leaks were from the cribriform plate, 22% sphenoid,
14% ethmoid, and 14% frontal sinus. In the traumatic CSF leak group: 33.3% were from
the cribriform plate, 33.3% sphenoid, 22.2% ethmoid, and 11.1% frontal.
Conclusion Endoscopic CSF fistula closure is a safe and effective operation. All sites of leak
can be accessed endoscopically. We recommend the use of an anatomic three-layered
closure in difficult cases.
Keywords
cerebrospinal fluid - rhinorrhea - endoscopic - skull base - spontaneous leaks
