Endoscopic endonasal multilayer repair of traumatic CSF rhinorrhea

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• 作者：Ahmed Aly Ibrahim ; Mohamed Okasha…
• 关键词：CSF leak ; ESS ; RTA ; Skull base ; Endoscopic ; Repair
• 刊名：European Archives of Oto-Rhino-Laryngology
• 出版年：2016
• 出版时间：April 2016
• 年：2016
• 卷：273
• 期：4
• 页码：921-926
• 全文大小：1,184 KB
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• 作者单位：Ahmed Aly Ibrahim (1)
  Mohamed Okasha (2)
  Samy Elwany (1)
  
  1. Department of Otolaryngology, Alexandria Medical School, Alexandria, Egypt
  2. Department of Neurosurgery, Damanhur Medical National Institute, Damanhur, Egypt
  
• 刊物类别：Medicine
• 刊物主题：Medicine & Public Health
  Otorhinolaryngology
  Neurosurgery
  Head and Neck Surgery
  
• 出版者：Springer Berlin / Heidelberg
• ISSN：1434-4726

文摘

The incidence of traumatic CSF has increased in recent years due to increased incidence of road traffic accidents (RTA) as well the increasing number of endoscopic sinus surgeries (ESS). The objective of this study is to present our experience in management of traumatic CSF leaks using the endoscopic multilayer repair technique. Forty-two patients (aged 10–75 years, 30 males and 12 females) presenting with confirmed post-traumatic CSF rhinorrhea were operated upon between January 2007 and December 2013. The endoscopic multilayer technique was used in all cases. Electromagnetic navigation was used in some cases. All cases presented with intermittent watery rhinorrhea. The duration of the rhinorrhea ranged from 3 days to 1 year before repair. One case presented after 10 years from the causative trauma. Ten cases had a history of meningitis. Nine cases had more than one defect. Iatrogenic defects were larger than defects following accidental trauma. Two cases, following RTA, developed pseudo-aneurysm of internal carotid artery. Ten cases had associated pneumocephalus. The mean duration of postoperative hospitalization was 6 days (range 4–8 days). The mean follow-up duration was 31.2 +/− 11.4 months (range 16–48 months). None of our patient developed serious intra- or postoperative complications. Only one case required another surgery to repair a missed second defect. Post-traumatic CSF leaks can be successfully managed via the endonasal endoscopic route using the multilayer repair technique. It is important to look for multiple defects in these cases. CT angiography is recommended for traumatic leaks involving the lateral wall of the sphenoid sinus to diagnose or exclude the development of pseudo-aneurysm of the internal carotid artery.