Effectiveness of endoscopic surgery for treating spontaneous cerebrospinal fluid rhinorrhea

Abstract

Background and Objective

Spontaneous Cerebrospinal Fluid (CSF) rhinorrhea is a rare but potentially serious condition characterized by the leakage of CSF through the nasal cavity without an apparent traumatic or iatrogenic cause.

Materials and Methods

The current study was a five-year retrospective cross-sectional study on 24 patients with a history of spontaneous Cerebrospinal Fluid (CSF) rhinorrhea who underwent endoscopic surgery. The patients were selected among 90 individuals with CSF leaks.The required information was extracted from their medical records. The collected data included patient demographics, BMI, presenting symptoms, radiologic imaging findings, defect site, materials used for skull base repair, postoperative complications, and the success rate of endoscopic treatment.

Results

The patients who experienced spontaneous Cerebrospinal Fluid (CSF) leaks were primarily obese, middle-aged women. All patients presented with intermittent watery rhinorrhea, and 25% experienced positional headaches. Computed Tomography (CT) and magnetic resonance imaging (MRI) identified leak sites in 20 patients (83.3%). In cases where CT and MRI were inconclusive, CT cisternography was used (16.6%). The most common intraoperative defect site was the fovea ethmoidalis (50%). In 30% of patients, a single-layer reconstruction with only a fat graft was performed. Postoperative complications were observed in five patients (20%). Two patients developed meningitis postoperatively, which resolved with antibiotic treatment, and three patients experienced complete and permanent anosmia. Successful primary repair was achieved in 23 patients (96%), with a relapse rate of 4%.

Conclusion

Endoscopic surgery had a high success rate (96%) for the repair of spontaneous CSF rhinorrhea, with minimal recurrence (4%). The technique, particularly the multilayer approach, was effective in managing this condition.