A Prospective Examination For The Operation Of Traumatic Cerebrospinal Fluid Rhinorrhea

Background: Traumatic cerebrospinal fluid (CSF) rhinorrhea is a frequent disorder after traumatic craniofacial injuries. The purpose of this study was to find the way for preoperative localization of fistulas, and discuss the surgical management guided by the outcomes of preoperative localization.Methods: 32 patients with traumatic CSF rhinorrhea undergoing surgical management were reviewed in this study. High resolution CT and MR cisternography were performed for preoperative localization of fistulas in all of them. And specific surgical approach to closure of the fistulas was performed in selected cases under the guidance of preoperative localization, including frontal craniotomy, transsphenoidal surgery and supraorbital keyhole surgery. The statistical analysis of the preoperative localization either using high resolution CT or MR cisternography as compared with surgical findings was performed, as well as the sensitivity and accuracy of the n(?)uroimaging techniques used for the localization.Results: Both of the two techniques used in this study were effective in localization of fistulas, while high resolution CT had an accuracy of 85% for preoperative localization, and MR cisternography had an accuracy of 86%. An accuracy of 89% was found after combined the two methods, and there were no statistical differences among these methods and the discovering in the operation. In this series, follow-up performed successfully in 27 patients showed that 93% of patients were successfully treated.Conclusion: Either high resolution CT or MR cisternography is effective in the preoperative localization of the fistulas for traumatic CSF rhinorrhea, and combined the two techniques cloud get higher sensitivity and accuracy. According to preoperative localization of fistulas, as well as the conditions of basilar skull fracture, we could choose the appropriate surgical approach to this disorder with least trauma and higher successful rate.