Analysis And Discussion Of The Treatment For 16 Cases Of Cerebrospinal Fluid Rhinorrhea By The Nasal Endoscopic

Objective:To study the diagnosis, methods and indications of nasal endoscopic repair of cerebrospinal fluid rhinorrhea, and to discuss the determination of repair ways and choice of appropriate repair materials based on the location and range of defect.Methods:16 patients were included in this study. All cases suffered from cerebrospinal fluid rhinorrhea and received nasal endoscopic repair in the department of Otolaryngology, the Second Clinical College of Shanxi Medical University from September 2011 to February2015. The clinical data including clinical features, preoperative localization of leaks,surgical methods and repair materials were analyzed retrospectively.Results:The repair got accomplished endoscopically in all 16 cases. Of them, 9 were male and 7 were female, ranging in age from 19 to 66 years old. Intraoperative confirmation showed that the sites of leaks located at the external and posterior walls of sphenoid sinus in 7 cases, roof of sphenoid sinus in 2, cribriform roof in 2, sellar floor in one, paries posterior of frontal sinus in 2, and the junction between sphenoid and ethmoidal sinus in one. As for the repair materials, 4 cases were repaired with sarcoplasm, fascia and mucosal flap, one with pure fascia, 3 with sarcoplasm and fascia, 2 with fascia and fat, 2with fascia and mucosal flap, 3 with pure mucosal flap, one with septal cartilage, fascia and mucosal flap. The surgery process was successful, and the ventages were coalescedperfectly in all cases. All the 16 patients had been followed up for 2 months to 3 years postoperatively. During the follow-up period, contralateral cerebrospinal fluid rhinorrhea occurred in one patient with preoperative spontaneous cerebrospinal fluid leak, and no recurrence in the others.Conclusion:1. Nasal endoscopic repair is a safe and reliable surgical method for cerebrospinal fluid rhinorrhea in ethmoid sinus and sphenoid sinus. As for the complicated cerebrospinal fluid rhinorrhea located in frontal sinus, combination of superciliary arch incision and nasal endoscopic approach, which can solve the problems including limited surgical field and insufficient operational space in nasal endoscopic approach at the most,should be considered.2. Iatrogenic cerebrospinal fluid leak occurred during transcranial or endoscopic surgical process should be found in time, and primary repaired.3. For preoperative localization of the ventage, thin-layer CT scanning, MRI and nasal endoscopy should be performed. During operation, the ventage should be precisely localized based on the preoperative examinations.4. It is the key for successful repair to choose the appropriate repair materials according to the location and size of the ventage.