Endonasal endoscopic management of spontaneous cerebrospinal fluid rhinorrhoea: The Birmingham UK experience.
Jolly, Karan Gupta, Keshav Kumar Bhamra, Navdeep Aslanidou, Anastasia Batra, Ruchika Ahmed, Shahzada K
Jolly, Karan
Gupta, Keshav Kumar
Bhamra, Navdeep
Aslanidou, Anastasia
Batra, Ruchika
Ahmed, Shahzada K
Abstract
Background: Spontaneous cerebrospinal fluid (CSF) leaks (SCSFL) occur in the absence of trauma, surgery, or underlying intracranial pathology. They represent a significant healthcare burden on patients with complications such as meningitis. We present our experience of SCSFL repair via the endonasal endoscopic approach.
Methods: All patients who underwent CSF fistula repair at a tertiary UK hospital, between 1st January 2012 to 31st December 2019, were identified and had their case notes analyzed retrospectively.
Results: There were 33 patients included consisting of 27 (81.8%) females, with age range from 31 to 81 years (mean 55.2). Mean body mass index (BMI) was 35.2 kg/m2 , with 32 (97.0%) patients overweight (BMI >25). All patients presented with intermittent watery rhinorrhoea and had a positive biochemical analysis. Computed tomography (CT) and/or magnetic resonance imaging (MRI) identified leak sites in 29 patients (87.9%). The most common intraoperative defect site was the cribriform plate (42.4%). A variety of closing techniques were used including onlay grafts (72.7%), tissue glue (87.9%), nasoseptal flaps (63.6%), mucosal free grafts (21.2%), fat grafts (21.2%), and additional support materials (87.9%). Nasal packing was used in all patients. The average length of stay was 1.6 days. Postoperative complications occurred in two patients (6.1%) (meningitis, epistaxis). Overall, there was a successful primary repair in 32 (97.0%) patients with most cases employing a multilayered reconstruction method (78.8%).
Conclusion: Our results demonstrate excellent success rates with the endoscopic endonasal approach to SCSFL. This adds to the literature by demonstrating a detailed analysis of the experience in SCSFL management in one of the largest UK centres.
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Date
2022-09-18
Type
Article
Subject
Ear, Nose & Throat
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Citation
Jolly K, Gupta KK, Bhamra N, Aslanidou A, Batra R, Ahmed SK. Endonasal endoscopic management of spontaneous cerebrospinal fluid rhinorrhoea: The Birmingham UK experience. Asian J Endosc Surg. 2023 Jan;16(1):68-76. doi: 10.1111/ases.13125. Epub 2022 Sep 18
Journal / Source Title
Asian Journal of Endoscopic Surgery
DOI
10.1111/ases.13125
PMID
36116916
Publisher
Wiley
Publisher’s URL
http://onlinelibrary.wiley.com/journal/10.1111/(ISSN)1758-5910