Physical examination: Complete ear, nose, throat, head and neck examination, cranial nerves assessment, and Fiberoptic evaluation of the nasal cavity looking for the site of the leak (commonly in cribriform plate, ethmoid roof, sphenoid sinus wall, frontal sinus posterior table). | 2014 May;271(5):1073-9. doi: 10.1007/s00405-013-2674-y. Figure 4: Overlay technique, where the graft is applied as a lining for the roof of the sinonasal cavity.
| Neurosurgery 62(2): 463-469.
National Center for Biotechnology Information, Unable to load your collection due to an error, Unable to load your delegates due to an error. Lanza DC, O’Brien DA, Kennedy DW (1996) Endoscopic repair of cerebrospinal fluid fistulae and encephaloceles. Combination of both HRCT and MRI-cisternography provide higher sensitivity and specificity, but usually it is not cost effective and sometimes its time consuming to wait for both to be ready. Neurosurgery 58(4 Suppl 2): ONS-246-256.
Causes include spontaneous CSF rhinorrhea, elevated body mass index, extensive skull base defects, middle age, female gender, diabetic patients, in cases of multiple leaks, those with high intracranial pressure [63,64,65].
This diagnostic modality is not approved by United States Food and Drug Administration yet. Neurosurgical focus 32(6): E3.
Meier JC, Bleier BS (2013) Novel techniques and the future of skull base reconstruction. Neither sensitive nor specific [12]. Conservative management, for 2-4 weeks [26], especially for traumatic leaks.
Intrathecal fluorescein [19,20,21] where 0.1 ml of 10% fluorescein is diluted in 10 ml of CSF and injected into the subarachnoid space over a period of 10 minutes, then nasal endoscopy to be done 30 minutes later, fluid can be seen by routine xenon light. Auris Nasus Larynx 34(4): 515-518. Please type the correct Captcha word to see email ID. If more than 50% increase, it is leak. Spontaneous, traumatic, or iatrogenic CSF leak, Edges of skull base defect identified and freshened, Underlay cartilage graft placed extra-durally, Free mucosal graft from septum or turbinate placed over defect, Graft held firmly in place with absorbable packing material, Most intraop leaks can be successfully closed with one-layer repair, Spontaneous leaks are often closed with two layers, A non-absorbable packing material may be placed for a one-week period of time in order to further bolster the repair site.
So, starting with HRCT is advised [12,13,17]. El Shazly AA, El Wardany MA, Abo El Ezz TA (2016) Sellar repair with autologous muscle and composite septal cartilage grafts for treatment of cerebrospinal fluid leakage following trans-sphenoidal pituitary surgery.
The mucosa is completely stripped away from the defect for at least 5 mm in all the directions. Material and methods: A literature search was performed on PubMed, Medline and Cochrane Central databases, independently by two of the authors, of all studies reporting the outcomes of CSF rhinorrhoea repair, published until the 1st June 2014, using keywords Cerebrospinal fluid leak, CSF leak, CSF fistula, CSF leak or fistula repair, endoscopic sinus surgery or ESS complications. Otorhinolaryngologist Asir central Hospital, Saudi Arabia, Correspondence: Ibrahim Sumaily Otorhinolaryngologist Asir central Hospital Abha KSA, Saudi Arabia, Tel +966504621902, Received: April 11, 2017 | Published: May 2, 2017, Citation: Sumaily I (2017) Current Approach to Cerebrospinal Fluid Rhinorrhea Diagnosis and Management.
The diagnosis of CSF Rhinorrhea is established on 3 main aspects: This can be classified into primary and secondary: Primary (helpful in the detection of most of the leaks) [10,11]: Secondary (useful if primary modalities failed to show the site of the leak)[12]: Figure 2: Suggested algorithmic approach for CSF rhinorrhea.
Also with this approach it is difficult to approach sphenoid sinus rhinorrhea. A systematic review of the endoscopic repair of cerebrospinal fluid leaks. Indian J Otolaryngol Head Neck Surg. A case report and literature review. Neurosurgery 65(6 Suppl): 65-71. Successful management has been reported using a variety of repair techniques.
The sphenoid sinus is the most common location for CSF leak repair failure. Rhinology 51(3): 268-274. Landeiro JA, Flores MS, Lázaro BC, Melo MH (2004) Surgical management of cerebrospinal fluid rhinorrhea under endoscopic control. NLM Schlosser RJ, Wilensky EM, Grady MS, Bolger WE (2003) Elevated intracranial pressures in spontaneous cerebrospinal fluid leaks.
Zhonghua Er Bi Yan Hou Ke Za Zhi 37(5): 366-369.
Several Graft materials can be used; cartilage, bone, mucoperichondrium, septal mucosa, turbinate, fascia, abdominal fat, conchal cartilage, free tissue, pedicle tissue or composite grafts.
J Oral Maxillofac Surg 62(6): 676-684. Anverali JK, Hassaan AA, Saleh HA (2009) Endoscopic modified Lothrop procedure for repair of lateral frontal sinus cerebrospinal fluid leak. Adv Otorhinolaryngol 74: 174-183. Get the latest research from NIH: https://www.nih.gov/coronavirus.
Tissue sealants to add stability to a multilayered repair.
Outcome of Endoscopic Cerebrospinal Fluid Rhinorrhoea Repair: An Institutional Study. NIH McCoul ED, Anand VK, Singh A, Nyquist GG, Schaberg MR, et al.
This is an open access article distributed under the terms of the
Cerebrospinal fluid (CSF) rhinorrhea clinical approach and therapeutic techniques are rapidly growing and the literature is almost daily enriched with new studies, techniques, and trials.
There is risk of developing seizures due to fluorescein [23]. Useful in cases of frontal and sphenoid sinus defects with or without meningocele or encephalocele [59,60,61], and in those with high ICP. Nowadays sandwich technique, by combining intradural and extradural grafts, is the trend among the experts and seen to adds more security to the sealing of CSF and augments the results of repair [55].
Laryngoscope 106(9 pt 1): 1119-1125. Bhatti SN, Khan SA, Shah R, Aurangzeb A, Ahmed E, Rizvi F, Zadran KK, Alvi N. J Ayub Med Coll Abbottabad. Int Forum Allergy Rhinol 3(9): 718-721. Epub 2012 Jun 15. Al-Sebeih K, Karagiozov K, Elbeltagi A, Al-Qattan F (2005) Non-traumaticcerebrospinal fluid rhinorrhea: Diagnosis and management. Procedure: up to date, no studies on the types of craniotomy and which type is preferred [31]. For all of this advantages, nowadays, it is the procedure of choice [37-39], especially in cases where there is small defects in the sphenoid sinus, cribriform plate, anterior and posterior ethmoid sinus.