Cerebrospinal Fluid Rhinorrhea: The Place for Endoscopic Surgery

Cerebrospinal fluid (CSF) rhinorrhea has been managed by both neurosurgeons and otorhinolaryngologists, with neurosurgeons often choosing an intracranial approach and otorhinolaryngologists an extracranial approach. Recently, transnasal endoscopic techniques have been introduced that significantly reduce the morbidity of surgical repair when compared with previous techniques. The sense of smell was preserved in all patients who underwent an endoscopic repair of their CSF leak where it was present preoperatively. The results of transnasal endoscopic repair now make it the treatment of choice for most anterior cranial and sphenoid CSF leaks, with the exception of defects in posterior wall of the frontal sinus. It is vital that a diagnosis of a CSF leak is confirmed by preoperative examination including computed tomographic scans; nasal endoscopy; measurement of glucose concentration in the nasal discharge; and, in some cases, cisternographic evaluation via computed tomography and/or magnetic resonance imaging. Telescopes, conventional endoscopic sinus surgery instruments, and a microdebrider were used for all patients who underwent endonasal surgery. A combination of abdominal fat, fascia lata, cartilage and fibrin glue, were used for fistula repair. This article illustrates our experience with nineteen patients who were referred with a diagnosis of CSF rhinorrhea by neurosurgeons of our institution.