Publication:

Endoscopic trans nasal intervention in cerebrospinal fluid rhinorrhea: a one and half-year pilot study

Background Cerebrospinal rhinorrhea from the anterior and middle skull base was repaired through the inferior intra-nasal corridor under high resolution endoscopic visualization. The sites, tissues utilized and the surgical outcome have been critically analyzed.

Methods 47 subjects of skull base lesions underwent surgical intervention jointly in the Departments of Otolaryngology and Neurosurgery, Dayanand Medical College and Hospital, Ludhiana during a period of 1.5 year.

Results Trans-nasal endoscopic intervention for cerebrospinal fluid rhinorrhea was undertaken in 1 male (14.3%) and 6 female (85.7%) patients. The minimum age in our study was 28 years and maximum 68 years with mean age 49.9 years. 6 (85.7%) patients had a history of spontaneous cerebrospinal fluid leak while 1 (14.3%) had a history of trauma prior to the leak. The body mass index (BMI) of 6 (85.7%) was in the range of 30.0–34.9.              Total 6 (85.7%) patients of cerebrospinal fluid leak presented with rhinorrhea or watery nasal discharge as the chief complaint. The cribriform plate, as seen in 5 (71.4%) patients, was the predominant site of cerebrospinal fluid rhinorrhea, followed by the sphenoid, 2 (28.6%) and the fovea ethmoidalis 1 (14.3%). The tissue utilized as graft were fascia lata (7 patients), nasoseptal flap also known as the Hadad-Bassagasteguy flap (5 patients) and middle turbinate mucosa                 (1 patient).

Conclusions Spontaneous leaks from the cribriform plate outnumbered traumatic leaks male to female ratio was higher 1:6 in the 5th decade. Hadad-Bassagasteguy flap (in isolation or with fascia lata graft) as reconstructive material is used more commonly as compared to fascia lata.