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VOLUME 3 , ISSUE 3 ( September-December, 2011 ) > List of Articles

RESEARCH ARTICLE

Spontaneous CSF Leaks and Meningoencephaloceles: Endoscopic Repair and Possible Etiology

Andrey S Lopatin, Dmitry N Kapitanov, Alexander A Potapov

Keywords : Spontaneous cerebrospinal fluid leaks,Endoscopic skull base surgery,Sphenoid sinus

Citation Information : Lopatin AS, Kapitanov DN, Potapov AA. Spontaneous CSF Leaks and Meningoencephaloceles: Endoscopic Repair and Possible Etiology. Int J Otorhinolaryngol Clin 2011; 3 (3):151-155.

DOI: 10.5005/jp-journals-10003-1074

Published Online: 01-12-2011

Copyright Statement:  Copyright © 2011; Jaypee Brothers Medical Publishers (P) Ltd.


Abstract

Objective

To assess the outcomes of endonasal endoscopic repair of spontaneous cerebrospinal fluid (CSF) rhinorrhea and to analyze its possible etiological factors.

Patients

During the period between January 1999 and November 2011, 173 patients who presented with spontaneous CSF rhinorrhea underwent endonasal endoscopic surgery. Preoperative examination included CT scans, nasal endoscopy, measurement of glucose concentration in the nasal discharge and, in some cases, cisternographic evaluation via CT or MRI. CSF fistula closure was performed using endonasal endoscopic technique under general anesthesia. In all, 186 surgeries (173 primary attempts and 13 revisions) were carried out over the 12-year period. A combination of different plastic materials, i.e. nasal septum cartilage, facia lata, abdominal fat, rotating middle turbinate flaps, and fibrin glue was used for fistula repair.

Results

At the time of the surgery, sites of the CSF fistula were determined as follows: Cribriform plate—70, fovea ethmoidalis—55, sphenoid sinus—45, frontal sinus—3. Extremely pneumatized lateral extension of the sphenoid sinus was found in 26 patients, and a meningo/encephalocele protruding through the bony defect was the source of the leak in 23 of them. In terms of up to 11 years, 165 patients were treated successfully after first attempt and five more recovered after revision endoscopic surgery. Success rate after the first surgery was 95.4%, overall success rate—97.7%. There were no postoperative complications.

Conclusion

Possible etiological factors of this disease include obesity, innate skull base malformations, overpneumatized sphenoid sinus, particularly presence of its lateral extensions and the empty sella syndrome. Endoscopic endonasal repair of spontaneous CSF rhinorrhea appears to be a safe and successful procedure. However, technique of endoscopic closure of CSF fistulas in the lateral part of the sphenoid sinus needs further perfection.


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  1. Endonasal endoscopic closure of cerebrospinal fluid fistulas at the anterior cranial base. Ann Otol Rhinol Laryngol 1996;105:620–23.
  2. Endoscopic repair of cerebrospinal fluid fistulae and encephaloceles. Laryngoscope 1996;106:1119–25.
  3. The cerebrospinal fluid; its spontaneous escape from the nose. London: Cassel & Co 1899.
  4. Primary spontaneous cerebrospinal fluid rhinorrhea. Otolaryngol Head Neck Surg 1991;104:425–32.
  5. The surgical management of spontaneous cerebrospinal rhinorrhea. Arch Otolaryngol 1960;72:254–55.
  6. Spontaneous cerebrospinal fluid rhinorrhea. Evolving concepts in diagnosis and surgical management based on the Mayo Clinic experience from 1970 to 1981. Neurosurgery 1985;16:314–23.
  7. A clinical study of spontaneous CSF rhinorrhea. Rhinology 1991;29:223–30.
  8. Long-term results of frontobasal duraplasty. HNO 1997;45:117–22.
  9. Occult malformations of the skull base. Arch Otolaryngol Head Neck Surg 1997;123:77–80.
  10. Primary spontaneous cerebrospinal fluid rhinorrhea and obesity. Am J Rhinol 2001;15:117–19.
  11. Benign intracranial hypertension: A cause of CSF rhinorrhea. J Neurol Neurosurg Psychiatry 1994;57:847–49.
  12. Study on spontaneous fluid rhinorrhea: Its etiology and management. J Laryngol Otol 2005;119:12–15.
  13. Endonasal endoscopic repair of spontaneous cerebrospinal fluid leaks. Arch Otolaryngol Head Neck Surg 2003;129:859–63.
  14. A retrospective analysis of spontaneous sphenoid sinus fistula: MR and CT findings. Am J Neuroradiol 2000;21: 337–42.
  15. Evaluation of CT and MR cisternography in the diagnosis of cerebrospinal fluid fistula. Am J Neuroradiol 1998;19:633–39.
  16. Ein bisher noch nicht beschriebener Kanal im Keilbein des Menschen. Anat Anz 1888;3:225–53.
  17. Cruveilhier-Sternberg embryonal canal (lateral craniopharyngeal canal) and its vestiges in the adult human. Rev Laryngol Otol Rhinol 1956;77(3-4):223–32.
  18. Sternberg's canal–cause of congenital sphenoidal meningocele. Eur Arch Otorhinolaryngol 2000;257:430–32.
  19. Endonasal endoscopic repair of Sternberg's canal cerebrospinal fluid leaks. Laryngoscope 2007;117:345–49.
  20. Spontaneous CSF-leaks and meningoencephaloceles in sphenoid sinus by persisting Sternberg's canal. Rhinology 2009;47:369–74.
  21. Spontaneous nasal cerebrospinal fluid leaks and empty sella syndrome: A clinical association. Am J Rhinol 2003;17:91–96.
  22. Endoscopic repair of cerebrospinal fluid rhinorrhea: Learning from our failures. Am J Rhinol 2001;15:333–42.
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