Endoscopic endonasal repair of spontaneous cerebrospinal fluid leaks using multilayer composite graft and vascularized pedicled middle turbinate flap technique
DOI:
https://doi.org/10.34631/sporl.1012Keywords:
cerebrospinal fluid leak, anterior skull base, spontaneous CSF leak, vascularized flap repairAbstract
Objective: Review of the series of nasosinusal CSF fistulas and evaluation of reconstruction treatment using the multilayer technique and pedicled flap in the middle turbinate by CENS.
Study design: retrospective
Material and Methods: review of the clinical files of the patients submitted
CENS for closure of spontaneous CSF fistulas
Results: Three cases of spontaneous fistulas, females, with a mean age of 48.6 years (range 23-72 years) with unilateral rhinorrhea and a history of meningitis. The presence of glucose and b2-transferrin was investigated in rhinorrhea. The imaging study was performed by cranial CT and sinus CT and RM. The bone defect was identified by imaging in all cases. The cribriform plate and the ethmoid roof were the sites involved. Surgical treatment was performed using the “multilayer” technique with a pedicled flap of the middle turbinate. There were no relapses after a mean follow-up of 30 months.
Conclusions: Surgical correction of spontaneous fistulas is indicated by the risk of intracranial infectious complications. Surgical correction by CENS using the multilayer technique is a safe and effective way to treat these defects.
References
Gilat H, Rappatort Z, Yaniv E. Endoscopic transnasal cerebrospinal fluid leak repairs: a 10 year experience. Isr Med Assoc J. 2011 Oct;13(10):597-600.
Yadav YR, Parihar V, Janakiram N, Pande S, Bajaj J, Namdev H. Endoscopic management of cerebrospinal fluid rhinorrhea. Asian J Neurosurg. Jul-Sep 2016;11(3):183-93. doi: 10.4103/1793-5482.145101.
Bradford A, Woodworth , Rodney J. Repair of anterior skull base defects and CSF leaks. In: Stilanos E. Kountakis, Metin Önerci, editors. Rhinologic and sleep apnea surgical tecniques. Berlin: Springer; 2007. p. 139-146.
Wormald, Peter-John Cerebrospinal fluid leak closure. Endoscopic Sinus Surgery: anatomy, three-dimensional reconstruction, and surgical techniques. New York: Thieme; 2005: p. 109-118.
Presutti L, Mattioli F, Villari D, Marchioni D, Alicandri-Ciufelli M. Transnasal endoscopic treatment of cerebrospinal fluid leak: a 17 year’s experience. Acta Otorhinolaryngol Ital. 2009 Aug;29(4):191-6.
Englhard AS, Volgger V, Leunig A, Meßmer CS, Ledderose GJ. Spontaneous nasal cerebrospinal fluid leaks: management of 24 patients over 11 years. Eur Arch Otorhinolaryngol. 2018 Oct;275(10):2487-2494. doi: 10.1007/s00405-018-5089-y.
Kim-Orden N, Shen J, Or M, Hur K, Zada G, Wrobel B. Endoscopic endonasal repair of spontaneous cerebrospinal fluid leaks using multilayer composite graft and vascularized pedicled nasoseptal flap technique. Allergy Rhinol (Providence). 2019 Nov 13;10:2152656719888622. doi: 10.1177/2152656719888622.
Chaaban MR, Illing E, Riley KO, Woodworth BA. Spontaneous cerebrospinal fluid leak repair: a five-year prospective evaluation. Laryngoscope. 2014 Jan;124(1):70-5. doi: 10.1002/lary.24160.
Elmorsy SM, Khafagy YW. Endoscopic management of spontaneous CSF rhinorrhea with septal graft and middle turbinate rotational flap technique: a review of 31 cases. Ear Nose Throat J. 2014 Jun;93(6):E14-9.
Deenadayal DS, Vidyasagar D, Naveen Kumar M, Sudhakshin P, Sharath Chandra SV, Hameed S. Spontaneous CSF rhinorrhea our experience. Indian J Otolaryngol Head Neck Surg. 2013 Aug;65(Suppl 2):271-5. doi: 10.1007/s12070-011-0431-3.
Gunaratne DA, Singh NP. Endoscopic pedicled nasoseptal flap repair of spontaneous sphenoid sinus cerebrospinal fluid leaks. BMJ Case Rep. 2015 Apr 29;2015:bcr2014209157. doi: 10.1136/bcr-2014-209157.
Fraser S, Gardner PA, Koutourousiou M, Kubik M, Fernandez-Miranda JC, Snyderman CH et al. Risk factors associated with postoperative cerebrospinal fluid leak after endoscopic endonasal skull base surgery. J Neurosurg. 2018 Apr;128(4):1066-1071. doi: 10.3171/2016.12.JNS1694.
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2022 Portuguese Journal of Otorhinolaryngology and Head and Neck Surgery
This work is licensed under a Creative Commons Attribution-ShareAlike 4.0 International License.
