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J Neurol Surg B Skull Base
DOI: 10.1055/a-2505-8170
Original Article

Endonasal Endoscopic Management of Cerebrospinal Fluid Rhinorrhea: A Study of 263 Patients

Sevil Nasirmohtaram
1   Otolaryngology Head Neck Surgery, Guilan University of Medical Sciences, Rasht, Iran
,
Farhad Arbabzade
2   Otolaryngology Head Neck Surgery Department, Tehran University of Medical Sciences, Tehran, Iran
,
Azin Tabari
2   Otolaryngology Head Neck Surgery Department, Tehran University of Medical Sciences, Tehran, Iran
,
Seyed Mousa Sadrehosseini
2   Otolaryngology Head Neck Surgery Department, Tehran University of Medical Sciences, Tehran, Iran
,
Mehdi Zeinalizadeh
3   Neurological Surgery, Tehran University of Medical Sciences, Tehran, Iran
,
Hassan R. Mohammadi
4   Neurological Surgery Department, Shahid Beheshti University of Medical Sciences, Tehran, Iran
,
Masoud Shirvani
5   Neurological Surgery Department, Salamat Farda hospital, Tehran, Iran
,
Abbas Amirjamshidi
6   Neurological Surgery Department, Arad hospital, Tehran, Iran
,
Abdolreza Shojaie
6   Neurological Surgery Department, Arad hospital, Tehran, Iran
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Abstract

Background Cerebrospinal fluid (CSF) rhinorrhea is a sign of a breach in the bony skull base. It should be verified, localized, and repaired surgically to alleviate the risk of intracranial infection. Endonasal endoscopic surgery is the standard technique for skull base reconstruction in these patients. The current study was undertaken to evaluate a large case series of patients with CSF rhinorrhea who underwent surgery, focusing on symptoms, etiology, specifics of skull base defects, reconstruction techniques, outcomes, and complications.

Methods All patients with CSF rhinorrhea who were treated endoscopically for a skull base defect from 2010 to 2023 in a tertiary referral hospital were included.

Results In this retrospective study, 263 patients were included. The chief presenting symptom was rhinorrhea. Spontaneous CSF leak was the most common etiologic factor, whereas accidental trauma accounted for about one-third of the cases. In cases of spontaneous CSF rhinorrhea, the most common sites of skull base defects were the cribriform plate, lateral lamella of the ethmoid, and the lateral recess of the sphenoid. The frontal sinus was the most common site of defect in cases of accidental traumatic CSF rhinorrhea. In the majority of cases, a two-layer technique using inlay fat and onlay fascia was employed for skull base reconstruction. Recurrences, including technical failures, missed skull base defects, and late new skull base defects, were observed in 10 cases (3.8%). Three patients developed meningitis in the early postoperative period, but all recovered uneventfully.

Conclusion Given the high success rate and low morbidity, all patients with CSF rhinorrhea should be counseled to undergo endoscopic surgery early.

Keywords

endoscopic skull base reconstruction - CSF rhinorrhea - skull base defect - skull base reconstruction


Publication History

Received: 22 September 2024

Accepted: 16 December 2024

Article published online:
13 January 2025

© 2025. Thieme. All rights reserved.

Georg Thieme Verlag KG
Oswald-Hesse-Straße 50, 70469 Stuttgart, Germany

 

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