PubMed · 10869155
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V Subramanyam, Muneeswarulu. 2000. CSF rhinorrhea.. https://pubmed.ncbi.nlm.nih.gov/10869155/
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PURPOSE OF REVIEW: Spontaneous nasal cerebrospinal fluid (CSF) leaks represent a distinct clinical entity that presents important diagnostic and therapeutic challenges. Recognition of the proper demographic group and presenting symptoms, as well as the radiologic features of this disease process, are integral to making the appropriate diagnosis. In addition, this patient group requires special perioperative and intraoperative considerations for suitable management. RECENT FINDINGS: Current literature echoes previously published success rates for endoscopic repair of CSF leaks at or above 90%. Success rates for closure of spontaneous CSF leaks, however, continue to be the lowest in comparison with other CSF leak etiologies. The increased failure rate for spontaneous CSF leak repair is likely due to the increased intracranial pressure present in this patient group. Patients with spontaneous CSF leaks are increasingly being recognized as belonging to a group inclusive of patients with benign intracranial hypertension and empty sella syndrome. SUMMARY: In this review, we highlight the demographic characteristics, clinical presentation and radiologic findings that distinguish spontaneous nasal CSF leak patients from those with other CSF leak etiologies. We also discuss perioperative measures advocated for patients with spontaneous nasal CSF leaks that may aid in the success of their surgical repair.
PURPOSE OF REVIEW: The purpose of this review is to discuss endoscopic management of cerebrospinal fluid leaks and to highlight recent advances in both outcomes and technique. RECENT FINDINGS: Endoscopic techniques targeting the repair of skull-base defects have evolved as instrumentation for intranasal use has developed. The principles of endoscopic repair mirror those of open repair, with emphasis placed on site identification, site preparation, accurate graft placement and postoperative management. Several patient factors will affect the surgical and medical care of patients with cerebrospinal fluid rhinorrhea, including location, cause and overall medical condition. Numerous techniques have been described and large series attest to high success rates. The use of radiographic image-guidance systems promises to advance localization of the leak site. Endoscopic repair of cerebrospinal fluid leaks remains an accurate and complete method for the repair of cerebrospinal fluid leaks with decreased operative morbidity. SUMMARY: Endoscopic repair of anterior skull-base defects has a high success rate and markedly decreased morbidity as compared with traditional intracranial approaches. The endoscopic approach should be considered the technique of choice for repair of most cerebrospinal fluid fistulae and skull-base defects.
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