Endoscopic Management of Cerebrospinal Fluid Rhinorrhea: The Charing Cross Experience

Objective: To describe our experience of cerebrospinal fluid (CSF) rhinorrhea in a large case series focusing on etiology, surgical approach, and long-term outcomes alongside perioperative management; to evaluate the efficacy of endoscopic CSF leak repairs and assess the differences between spontaneous and traumatic etiologies.

Design: Retrospective data analysis.

Methods: Chart review was performed for all patients with CSF rhinorrhea managed at Charing Cross Hospital from 2003 to 2011. Data regarding demographics, presentation, body mass index (BMI), site of leak, preoperative workup, surgical approach, postoperative care, success rates, and follow-up were collated.

Results: Forty-five patients were identified: 14 men and 31 women with a mean age of 47.6 years. Etiologically, 28 were spontaneous and 17 traumatic. Fascia lata was the dominant graft choice, along with septal cartilage, turbinate mucosa, fat, and bone pate in some cases. The success rate was 96% (43/45, of which 5 were revision cases) with the two failures requiring treatment for raised intracranial pressure. Mean follow-up was 20 months. BMI was 33.7 in spontaneous and 27.0 in traumatic cases (P < 0.05). Of the spontaneous leaks, 46% were of the cribriform plate (13), 29% sphenoid (8), 14% ethmoid (4), and 11% frontal (3). Site of the traumatic leaks were: 35% each cribriform plate and sphenoid (6), 18% ethmoid (3), and 12% frontal (2).

Conclusion: Endoscopic CSF fistula closure is a safe and effective operation that has become the standard of care for managing CSF rhinorrhea.