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

Abstract

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.