Hostname: page-component-78c5997874-mlc7c Total loading time: 0 Render date: 2024-11-10T13:30:29.407Z Has data issue: false hasContentIssue false
  • English
  • Français

The endoscopic treatment of cerebrospinal fluid rhinorrhoea: the Nottingham experience

Published online by Cambridge University Press:  29 June 2007

R. G. M. Hughes ,
N. S. Jones  and
I. J. A. Robertson
R. G. M. Hughes
Affiliation:
Department of Neurosurgery, Queen's Medical Centre, Nottingham, UK.
N. S. Jones*
Affiliation:
Department of Otorhinolaryngology, Queen's Medical Centre, Nottingham, UK.
I. J. A. Robertson
Affiliation:
Department of Neurosurgery, Queen's Medical Centre, Nottingham, UK.
*
Address for correspondence: N. S. Jones, Department of Otorhinolaryngology, Queen's Medical Centre, Nottingham NG7 2UH.
Get access Rights & Permissions [Opens in a new window]

Abstract

The conventional neurosurgical management of cerebrospinal fluid (CSF) rhinorrhoea has been by intracranial access. Otorhinolaryngologists have undertaken extracranial approaches where access has been possible, and more recently an endoscopic approach has been advocated. We report 17 patients with confirmed CSF rhinorrhoea treated with endoscopic techniques between 1993 and 1996. Follow-up ranged from four to 32 months and showed an overall closure rate of 16 out of 17 patients with no complications. No patient undergoing primary endoscopic repair developed anosmia. The use of fluorescein helped localize the site of the CSF leak in four patients in whom the computed tomography (CT) scan had not identified the site of the defect.

We conclude that the endoscope is a valuable tool in the evaluation and subsequent treatment of CSF rhinorrhoea. Where the skull base defect is accessible to the endoscope, we propose that an endoscopic approach should be considered as the preferred method.

Keywords

Cerebrospinal fluidRhinorrhoeaEndoscopy, surgeryParanasal sinuses
Type
Main Articles
Information
The Journal of Laryngology & Otology , Volume 111 , Issue 2 , February 1997 , pp. 125 - 128
Copyright
Copyright © JLO (1984) Limited 1997

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Amedee, R. G., Mann, W. J., Gilsbach, J. (1993) Microscopic endonasal surgery for repair of CSF leaks. American Journal of Rhinology 7: 1–4.CrossRefGoogle Scholar
Anand, V. K., Murali, R. K., Glasgold, M. J. (1995) Surgical decisions in the management of cerebrospinal fluid rhinorrhoea. Rhinology 33: 212–218.Google ScholarPubMed
Costa, H., Cerejo, A., Baptista, A., Vaz, R., Goncalves, M., Guimaraes, A., Amarante, J., Cruz, C., Guimaraes, F. (1993) The galea frontalis myofascial flap in anterior fossa CSF leaks. British Journal of Plastic Surgery 46: 503–507.Google Scholar
Dodson, E. E., Gross, C. W., Swerdloff, J. L., Gustafson, L. M. (1994) Transnasal endoscopic repair of cerebrospinal fluid rhinorrhoea and skull base defects: A review of twenty-nine cases. Otolaryngology – Head and Neck Surgery 111: 600–605.Google Scholar
Dohlman, G. (1948) Spontaneous cerebrospinal rhinorrhoea. Acta Otolaryngologica 67(Suppl): 20–23.Google Scholar
Handley, G. H., Goodson, M. A., Real, T. H. (1993) Transnasal endoscopic closure of anterior fossa cerebrospinal fluid fistula. Southern Medical Journal 86(2): 217–219.Google Scholar
Lloyd, M. N. H., Kimber, P. M., Burrows, E. H. (1994) Post-traumatic cerebrospinal fluid rhinorrhoea: Modern high-definition computed tomography is all that is required for the effective demonstration of the site of leakage. Clinical Radiology 49: 100–103.CrossRefGoogle ScholarPubMed
Mattox, D. E., Kennedy, D. W. (1990) Endoscopic management of cerebrospinal fluid leaks and cephaloceles. Laryngoscope 100: 857–862.CrossRefGoogle ScholarPubMed
Moseley, J. I., Carton, C. A., Stern, W. E. (1978) Spectrum of complications in the use of intrathecal fluorescein. Journal of Neurosurgery 48: 765–767.Google Scholar
Papay, F. A., Maggiano, H., Dominquez, S., Hassenbusch, S. J., Levine, H. L., Lavertu, P. (1989) Rigid endoscopic repair of paranasal sinus cerebrospinal fluid fistulas. Laryngoscope 99: 1195–1201.Google Scholar
Park, J-I., Strelzow, V. V., Friedman, W. H. (1983) Current management of cerebrospinal fluid rhinorrhoea. Laryngoscope 93: 1294–1300.Google Scholar
Porter, M. J., Brookes, G. B., Zeman, A. Z. J., Keir, G. (1992) Use of protein electrophoresis in the diagnosis of cerebrospinal fluid rhinorrhoea. Journal of Laryngology and Otology 106: 504–506.Google Scholar
Stammberger, H. (1991) Endoscopic Sinus Surgery. B. C. Decker, Philadelphia, pp 434–441.Google Scholar
Stankiewicz, J. A. (1987) Complications of endoscopic intranasal ethmoidectomy. Laryngoscope 97: 1270–1273.Google Scholar
Stankiewicz, J. A. (1991) Cerebrospinal fluid fistula and endoscopic sinus surgery. Laryngoscope 101: 250–256.Google Scholar
Wigand, M. E. (1981) Transnasal ethmoidectomy under endoscopical control. Rhinology 19: 7–15.Google Scholar
Yessenow, R. S., McCabe, B. F. (1989) The osteo-mucoperiosteal flap in repair of cerebrospinal fluid rhinorrhoea: A 20-year experience. Otolaryngology - Head and Neck Surgery 101: 555–558.Google Scholar
Yoon, J-H., Lee, J-G., Kim, S. H., Park, I. Y. (1995) Microscopical surgical management of cerebrospinal fluid rhinorrhoea with free grafts. Rhinology 33: 208–211.Google Scholar