Tags

Type your tag names separated by a space and hit enter

Analysis of Various Factors and Techniques to Improve Outcome of Surgical Management of 243 Cases of CSF Rhinorrhea.

Abstract

Cerebrospinal fluid (CSF) rhinorrhea occurs when there is a communication between subarachnoid space and sinonasal mucosa due to meningeal, osseous and mucosal defects in the cranial base leading to discharge of CSF from the nose. The risk of developing meningitis after CSF rhinorrhea may vary from 5.6 (Leech and Paterson in Lancet 1:1013-1016, 1973) to 60% (Eljarnel and Foy in Br J Neurosurg 5:275-279, 1991). Hence surgical management of CSF rhinorrhea is highly recommended. Transnasal endoscopic approach first described by Wigand in 1981, has been proven to be the approach of choice in comparison to intracranial and external nasal approach (Jones and Becker in Br Med J 322:122-123, 2001) in most cases. The next defining milestone was the pedicled naso septal vascularized flap described by Hadad et al. (Laryngoscope 116(10):1882-1886, 2006), which could be used to manage large defects. In the present study we assessed 243 cases of CSF rhinorrhea managed by transnasal endoscopic approach. We compared the various factors associated with CSF rhinorrhea and the correlation with the outcome of the surgical treatment. We also analyzed the different sites and techniques of surgical repair and have certain recommendations to improve the surgical outcome. The commonest cause of CSF leak was spontaneous (54.32%) and the commonest site was cribriform plate (43.24%). Patients presented most commonly with watery nasal discharge (82.3%). CT scan with cisternography or MR cisternography is the gold standard to identify the suspected site of leak. Out of 243 patients, 77.77% were operated using free grafts and 22.22% by flap repair. Results are comparable. Hence we would advise simple conservative technique with free grafts to reduce morbidity and shorten the postoperative recovery.

Authors+Show Affiliations

1Bombay Hospital, Mumbai, India.Hatat Polyclinic, Muscat, Oman.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

31275831

Citation

Shah, Nishit, and Mridula Rao. "Analysis of Various Factors and Techniques to Improve Outcome of Surgical Management of 243 Cases of CSF Rhinorrhea." Indian Journal of Otolaryngology and Head and Neck Surgery : Official Publication of the Association of Otolaryngologists of India, vol. 71, no. 2, 2019, pp. 201-205.
Shah N, Rao M. Analysis of Various Factors and Techniques to Improve Outcome of Surgical Management of 243 Cases of CSF Rhinorrhea. Indian J Otolaryngol Head Neck Surg. 2019;71(2):201-205.
Shah, N., & Rao, M. (2019). Analysis of Various Factors and Techniques to Improve Outcome of Surgical Management of 243 Cases of CSF Rhinorrhea. Indian Journal of Otolaryngology and Head and Neck Surgery : Official Publication of the Association of Otolaryngologists of India, 71(2), pp. 201-205. doi:10.1007/s12070-018-01579-6.
Shah N, Rao M. Analysis of Various Factors and Techniques to Improve Outcome of Surgical Management of 243 Cases of CSF Rhinorrhea. Indian J Otolaryngol Head Neck Surg. 2019;71(2):201-205. PubMed PMID: 31275831.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Analysis of Various Factors and Techniques to Improve Outcome of Surgical Management of 243 Cases of CSF Rhinorrhea. AU - Shah,Nishit, AU - Rao,Mridula, Y1 - 2019/01/08/ PY - 2018/12/15/received PY - 2018/12/27/accepted PY - 2020/06/01/pmc-release PY - 2019/7/6/entrez PY - 2019/7/6/pubmed PY - 2019/7/6/medline KW - CSF rhinorrhea KW - CT cisternography KW - Free flap KW - Hadad flap KW - MR cisternography KW - Transnasal endoscopic repair SP - 201 EP - 205 JF - Indian journal of otolaryngology and head and neck surgery : official publication of the Association of Otolaryngologists of India JO - Indian J Otolaryngol Head Neck Surg VL - 71 IS - 2 N2 - Cerebrospinal fluid (CSF) rhinorrhea occurs when there is a communication between subarachnoid space and sinonasal mucosa due to meningeal, osseous and mucosal defects in the cranial base leading to discharge of CSF from the nose. The risk of developing meningitis after CSF rhinorrhea may vary from 5.6 (Leech and Paterson in Lancet 1:1013-1016, 1973) to 60% (Eljarnel and Foy in Br J Neurosurg 5:275-279, 1991). Hence surgical management of CSF rhinorrhea is highly recommended. Transnasal endoscopic approach first described by Wigand in 1981, has been proven to be the approach of choice in comparison to intracranial and external nasal approach (Jones and Becker in Br Med J 322:122-123, 2001) in most cases. The next defining milestone was the pedicled naso septal vascularized flap described by Hadad et al. (Laryngoscope 116(10):1882-1886, 2006), which could be used to manage large defects. In the present study we assessed 243 cases of CSF rhinorrhea managed by transnasal endoscopic approach. We compared the various factors associated with CSF rhinorrhea and the correlation with the outcome of the surgical treatment. We also analyzed the different sites and techniques of surgical repair and have certain recommendations to improve the surgical outcome. The commonest cause of CSF leak was spontaneous (54.32%) and the commonest site was cribriform plate (43.24%). Patients presented most commonly with watery nasal discharge (82.3%). CT scan with cisternography or MR cisternography is the gold standard to identify the suspected site of leak. Out of 243 patients, 77.77% were operated using free grafts and 22.22% by flap repair. Results are comparable. Hence we would advise simple conservative technique with free grafts to reduce morbidity and shorten the postoperative recovery. SN - 2231-3796 UR - https://www.unboundmedicine.com/medline/citation/31275831/Analysis_of_Various_Factors_and_Techniques_to_Improve_Outcome_of_Surgical_Management_of_243_Cases_of_CSF_Rhinorrhea DB - PRIME DP - Unbound Medicine ER -
Unbound Prime app for iOS iPhone iPadUnbound PubMed app for AndroidAlso Available:
Unbound MEDLINE
Unbound PubMed app for WindowsUnbound PubMed app for MAC OSX Yosemite Macbook Air pro