•  
  •  
 

Article Type

Article

Abstract

Background: Cerebrospinal fluid (CSF) rhinorrhea may be traumatic, developmental, pathological, or spontaneous. Different routes were suggested to approach the defect and many techniques were introduced for repair.

Objective: To present a new classification of CSF rhinorrhea based on the detailed site of the skull base defect and to demonstrate how to utilize it in determining the best approach for repair.

Methods: Ninety four cases of CSF leak having 103 skull base defects were classified according to their detailed sites. The approach followed to repair the defect was designed according to the site of the leak. These approaches included the endoscopic transcribriform, transethmoid, axillary flap technique, transnasal transsphenoid, transpterygopalatine, direct transnasal and external osteoplastic flap.

Results: Transnasal endoscopic approach was useful to approach all sites except the lateral frontal sinus defects, where external osteoplastic flap was mandatory. Transcribriform approach was effective in anterior and posterior cribriform plate defects. Transethmoid approach was useful in anterior and posterior ethmoids leaks. Axillary flap technique was sufficient in medial frontal sinus and frontal recess lesions. Transnasal transsphenoid approach was efficient in central sphenoid sinus defects and transpterygopalatine fossa in lateral recess leaks. Direct transnasal approach was resorted to in case of absent middle turbinate. These different approaches offered enough exposure of the defect for repair. Primary closure was achieved in 93.9% of defects and secondary closure in 100%.

Conclusion: Classification of CSF rhinorrhea according to the detailed site of skull base defect helps select the most direct and least destructive approach with effective repair.

Keywords: Cerebrospinal fluid rhinorrhea, CSF leak, skull base defect, repair, classification, endoscopic surgery.

Download

Share

COinS