Surgical decisions in the management of cerebrospinal fluid rhinorrhoea.

The surgical management of cerebrospinal fluid (CSF) rhinorrhoea has changed significantly after the introduction of functional endoscopic sinus surgery in the management of sinusitis. The clear anatomical exposure of the roof of the nasal and the sinus cavities by the endoscope offers the surgeon an opportunity to identify the area of the CSF leak, which enables one to adequately plan the treatment. The incidence of iatrogenic CSF rhinorrhoea has also increased, especially after the introduction of endoscopic sinus surgery. This study and presentation will analyze the various medical and surgical decisions that can be offered in the management of CSF rhinorrhoea from the authors' combined 10-year experience. The early identification of high-risk patients prior to surgery will be stressed including the various diagnostic options which are currently available in isolating the leak. The technique of endoscopic repair in the surgical management of the various leaks and the timing of the repair will be discussed in detail.