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Article Type

Article

Abstract

Objective: Endoscopic sinus surgery has been established as the standard procedure for management of most cases of cerebrospinal fluid (CSF) rhinorrhea and meningoceles. Spontaneous leak represents the most common etiology, whether it is associated with idiopathic intracranial hypertension or not. Nevertheless, results of endoscopic repair of spontaneous CSF leaks represent the worst among other nonspontaneous etiologies in most literatures, with a wide range of success (25–87%).

Patients and methods: This is a retrospective study that included 52 cases of spontaneous CSF leak, which had been managed by endoscopic sinus surgery, in the last 8 years, in Kasr Alaini Hospital, Faculty of Medicine, Cairo University, and Shebin Alkom Teaching Hospital; and also some cases were done in New Kasr Alaini Teaching Hospital. Data collected included age, sex, manifestations of high intra cranial tension (ICT), duration of leak, site, method of repair, and whether repair was successful or not.

Results: In 52 cases with spontaneous CSF leak, successful repair was achieved in 73% (38 out of 52).
There were 41 (78.8%) female and 11 (21.2%) male patients. Success in female patients was 70.7% (29 of 41 cases), and success in male patients was 81.8% (9 of 11 cases). Manifestations of increased ICT were found in 17 of 52 cases (32%), where nine of them failed (52%). Leaks in the ethmoidal region represented 27 (52%) cases, sphenoidal region 19 (36.5%) cases, and frontal region six (11.5%) cases. There were three methods of repair: in the first group, repair was done with fat and overlay mucosal graft in 17 (33%) cases; in the second group, repair was done with under lay epidural graft plus overlay mucosal graft in 29 (56%) cases; and in the third group, an underlay graft was used, and in addition, an overlay septal flap was put in six (11%) cases.

Conclusion: Spontaneous CSF leak represents a common cause of CSF rhinorrhea. Success rate is in general lower than in other etiologies of CSF leaks. The outcome of the surgical intervention could be related to variable demographic and preoperative factors.

Keywords: Cerebrospinal fluid leak, endoscopic sinus surgery, prognostic factors, spontaneous.

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