S D Sharma1, G Kumar2, J Bal3, A Eweiss4. 1. Department of Otorhinolaryngology, Queens Hospital, Rom Valley Way, Romford, RM7 0AG Essex, United Kingdom. Electronic address: sunilsharma@doctors.org.uk. 2. Department of Otorhinolaryngology, Queens Hospital, Rom Valley Way, Romford, RM7 0AG Essex, United Kingdom. Electronic address: drgauravkr@gmail.com. 3. Department of Otorhinolaryngology, Queens Hospital, Rom Valley Way, Romford, RM7 0AG Essex, United Kingdom. Electronic address: jarnail.bal@bhrhospitals.nhs.uk. 4. Department of Otorhinolaryngology, Queens Hospital, Rom Valley Way, Romford, RM7 0AG Essex, United Kingdom. Electronic address: azews@yahoo.com.
Abstract
GOAL: The purpose of this review was to look at the success rate of transnasal endoscopic repair of CSF rhinorrhoea and the impact of patient factors, repair techniques and adjuvant treatment. 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. Sixty-seven papers were included for the review. RESULT: The repair of CSF rhinorrhoea has rapidly evolved over the past 30 years. Prior to the advent of the endoscopic approach, craniotomy was used for repairs, which carried a variable success rate and morbidity. More recently, there have been several case series and reports that describe various endoscopic methods and materials for repair, with mean success rate of 90% (range: 60-100%). The most common site of CSF leak is the ethmoid roof/cribriform plate region. Traumatic CSF leak, in particular iatrogenic, is still the most common cause. Imaging with CT and MRI remains the gold standard for localisation of CSF leaks. The sphenoid sinus is the most common location for CSF leak repair failure. Lumbar drains and antibiotics are used as adjuvant therapy to endoscopic repair, but their benefits are not clear; intrathecal fluorescein can be used to aid location of CSF leak, but should be reserved for more complex cases. Further work into graft materials used and adjuvant treatment is needed to make any meaningful conclusions about their efficacy. CONCLUSION: The literature demonstrates that endoscopic repair of CSF rhinorrhoea is safe and effective, with a very low complication rate. It has almost completely replaced the older open techniques.
GOAL: The purpose of this review was to look at the success rate of transnasal endoscopic repair of CSF rhinorrhoea and the impact of patient factors, repair techniques and adjuvant treatment. 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. Sixty-seven papers were included for the review. RESULT: The repair of CSF rhinorrhoea has rapidly evolved over the past 30 years. Prior to the advent of the endoscopic approach, craniotomy was used for repairs, which carried a variable success rate and morbidity. More recently, there have been several case series and reports that describe various endoscopic methods and materials for repair, with mean success rate of 90% (range: 60-100%). The most common site of CSF leak is the ethmoid roof/cribriform plate region. Traumatic CSF leak, in particular iatrogenic, is still the most common cause. Imaging with CT and MRI remains the gold standard for localisation of CSF leaks. The sphenoid sinus is the most common location for CSF leak repair failure. Lumbar drains and antibiotics are used as adjuvant therapy to endoscopic repair, but their benefits are not clear; intrathecal fluorescein can be used to aid location of CSF leak, but should be reserved for more complex cases. Further work into graft materials used and adjuvant treatment is needed to make any meaningful conclusions about their efficacy. CONCLUSION: The literature demonstrates that endoscopic repair of CSF rhinorrhoea is safe and effective, with a very low complication rate. It has almost completely replaced the older open techniques.
Authors: Mesut Yılmaz; Zeynep Bahadır; Berk Madendere; Rıza Taha Yüksel; Hasan Gökay; Ahmet Alperen Yiğitbaşı Journal: Otolaryngol Case Rep Date: 2021-06-18
Authors: Tomasz Lyson; Joanna Kisluk; Marek Alifier; Barbara Politynska-Lewko; Andrzej Sieskiewicz; Jan Kochanowicz; Joanna Reszec; Jacek Niklinski; Marek Rogowski; Joanna Konopinska; Zenon Mariak; Ricardo L Carrau Journal: Adv Med Sci Date: 2021-03-04 Impact factor: 2.852
Authors: Christine Steiert; Luisa M Kraus; Roland Roelz; Horst Urbach; Juergen Beck; Stephan Meckel; Juergen Grauvogel Journal: Biomed Res Int Date: 2022-04-29 Impact factor: 3.246