Abstract

Transnasal endoscopic repair is now the preferred treatment for most defect in the anterior cranial and sphenoid sinus. This paper aims to assess the outcomes of endoscopic management in treating cerebrospinal fluid (CSF) rhinorrhea at a tertiary care centre in northern India. Aims and Objectives : The goal of this study was to examine the outcomes of endoscopic management of cerebrospinal fluid (CSF) rhinorrhea through a collaborative effort between neurosurgeons and otorhinolaryngologists. Materials and methods: A retrospective analysis was conducted on 30 consecutive patients who underwent endoscopic repair of cerebrospinal fluid (CSF) rhinorrhea between 2021 and 2023. The endoscopic procedure involved identifying the defect and removing the surrounding mucosa for 3-4 mm. Repair was carried out using materials such as septal cartilage, fascia lata, oxidized cellulose, and fibrin sealant. In selected cases, a lumbar drain was placed for 2-4 days. Patients with spontaneous CSF rhinorrhea and high opening lumbar CSF pressure received a lumbar peritoneal shunt. Results: Spontaneous cerebrospinal fluid (CSF) leaks were found to be more prevalent among middle-aged females, while posttraumatic CSF leaks were commonly observed in young adult males. Following the initial surgery, success rates for patients with posttraumatic, spontaneous, and postprocedural CSF leaks saw significant improvement to 100% after a second procedure. Recurrence of leaks was attributed to various factors, including technical failures, poor graft uptake due to radiation therapy, the location of the leak in the lateral sphenoid recess, malfunction of lumbar peritoneal shunts, and inadequate healing of skull base fractures. Conclusions: Effective collaboration between neurosurgeons and otorhinolaryngologists is crucial for achieving a high success rate in endoscopic repair of cerebrospinal fluid (CSF) rhinorrhea. This teamwork involves meticulous attention to key steps, including identifying the site of the leak, preparing the graft bed, securely placing the graft, and providing comprehensive postoperative care. Such a coordinated approach enhances the overall success and outcomes of the endoscopic repair procedure for CSF rhinorrhea.

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