Clinical Analysis Of Fistula Location And Endoscopic Surgery For Spontaneous Cerebrospinal Fluid Rhinorrhea

Objective:The aim of this study was to develop a radiographic method for the diagnosis of spontaneous cerebrospinal fluid rhinorrhea,and to explore the endoscopic nasal nerve repair of cerebrospinal fluid leakage surgery methods,fistula repair techniques and the choice of repair materials.Method:From January 2014 to January 2019,21 patients with spontaneous cerebrospinal fluid rhinorrhea were selected,including 13 female patients and 8 male patients.Before operation,all patients with nasal leakage were examined quantitatively by glucose,and the position of Fistula was determined by CT and MRI in different postures.Endoscopic neurosurgery via nasal approach was performed and multiple repair techniques were used to repair the CSF Fistula.The clinical data and postoperative follow-up data were analyzed retrospectively.Results:There were 21 cases of skull base bone defect in CT examination.In 16 patients,the location of the fistula was determined by the fluid plane in the superior sinus cavity of CT in supine or prone position and continuous fluid leakage through the bone defect.The location of fistulae in 14 patients was determined by MRI T2 weighted images of brain crest fluid and meningoencephalocele.CT and MRI showed the location of Fistula in 20 patients,which was consistent with the location of intraoperative exploration.In another case,the fistula was finally located by endoscopic exploration.Of all the fistulas detected,10 were located in the sphenoid sinus,9 in the ethmoid plate,and 2 in the clivus(table 1).The empty sella was found in 3 patients.After follow-up for 3 months to 3 years,19 of the 21 cases were cured,2cases recurred and were cured after the second operation without complications.The success rate of primary closure was 90.5%,and the success rate of secondary closure was 100%.Conclusion:1.Before operation,CT and MRI T2 images of skull base in different postures can be used in patients with cerebrospinal fluid rhinorrhea,which is simple,accurate and non-invasive,and can be used as an important reference for locating fistula.2.Endoscopic transnasal neurosurgery and multiple repair of autogenous fascia and tissue are effective methods to repair the fistula.