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Abstract

Background: Cerebrospinal fluid (CSF) leaks can arise as a complication of trauma, hydrocephalus,endoscopic sinus surgery or it may occur spontaneously without any identifiable cause. Surgicalrepair is recommended in patients who do not respond to the conservative management. In recentyears transnasal endoscopic approach has become the preferred method for repairing the CSF leaksand better outcomes have been reported as compared to the intracranial approaches that werepreviously used. Objective of this study was to analyse the outcome of transnasal endoscopic repairof CSF rhinorrhoea. Methods: This prospective study was conducted in the Department ofNeurosurgery, Ayub Medical College, Abbottabad, from March 2007 to March 2010. Twenty-onepatients with CSF rhinorrhoea were included in study that were diagnosed on the basis of clinicalevaluation, glucose concentration of nasal discharge, computed tomography (CT) and magneticresonance imaging (MRI). These patients did not respond to conservative management and wereoperated transnasally using rigid endoscope. Patients were followed up for a mean duration of 9months and the outcome was analysed. Results: The patients included in the study ranged in the agegroup of 12-55 years. Among the patients 13 (57%) were female and 8 (38%) were males. The causeof CSF rhinorrhoea was traumatic in 16 (76.19%), Idiopathic or spontaneous in 4 (19.04%) and 1(4.7%) case was related to endoscopic surgery for pituitary macroedenoma. In 10 (47.6.8%) patientsthe site of leak was cribriform plate, 5 (23.8%) had from sphenoid, 4 (19.04%) from frontal sinus andin 2 (9.5%) Ethmoid was affected. Primary surgery was successful in 17 (80.95%) of cases. In 2(9.5%) cases re-exploration had to be performed. In 1 patient re-exploration had to be done for thethird time. Overall success rate was 95%. One patient presented with CSF leak and meningitis 1month after surgery and unfortunately died. Conclusion: Transnasal endoscopic repair of CSFrhinorrhoea is highly successful, safe and less traumatic.Keywords: Transnasal endoscopic repair, CSF Rhinorrhoea, CSF leak, transnasal endoscopicduroplasty