Endoscopic closure of CSF rhinorrhea: 193 cases over 21 years
Presented at the Annual Meeting of the American Academy of Otolaryngology–Head and Neck Surgery, Chicago, Illinois, September 21-24, 2008.
Received 26 September 2008; received in revised form 15 December 2008; accepted 24 December 2008. published online 02 March 2009.
Abstract
Objective
Endoscopic repair of cerebrospinal fluid (CSF) leaks has become a routine approach. This study describes endoscopic closure of a large series over 21 years, focusing on management, surgical technique, and long-term outcomes.
Study Design
Chart review.
Subjects and Methods
CSF leak patients treated by the senior author and at the University of Pennsylvania from 1987 to 2008. The data included body mass index (BMI), etiology, defect location, graft material, presence of encephalocele, lumbar drain, history of meningitis, intracranial pressure, recurrence, and follow-up.
Results
A total of 193 cases were identified. Follow-up ranging from 1 month to 9 years (mean 21 months) was available on 166 patients. The etiology was spontaneous in 77 patients (40%), traumatic in 109 (56%), and congenital in 7 (4%). The average BMI of spontaneous CSF leak patients (35) was greater (P < 0.001) than both traumatic (30) and congenital patients (23). Defects were most commonly located in the sphenoid (n = 62, 32%) and ethmoid (n = 60, 31%) The initial success rate was 91 percent (n = 176) and overall success rate was 98 percent (n = 190).
Conclusion
The overall success rate (98%) and low morbidity in this large series support endoscopic approach as standard of care for CSF leak closure.
Department of Otorhinolaryngology–Head and Neck Surgery, University of Pennsylvania Health System, Philadelphia, PA
Corresponding author: David W. Kennedy, MD, Department of Otorhinolaryngology, 21 Penn Tower, 399 S. 34th St, Philadelphia, PA 19104-4385
Sponsorship or competing interests that may be relevant to content are disclosed at the end of this article.
ABSTRACT