Abstract
Background: Cerebrospinal fluid (CSF) rhinorrhea occurs due to communication between the intracranial subarachnoid space and the sinonasal mucosa. It could be due to trauma, raised intracranial pressure (ICP), tumors, erosive diseases, and congenital skull defects. Some leaks could be spontaneous without any specific etiology. The potential leak sites include the cribriform plate, ethmoid, sphenoid, and frontal sinus.
Methods: We retrospectively reviewed the medical records of 26 patients who underwent endoscopic repair of CSF rhinorrhoea with image-guided neuronavigation (IGN) between 2018 and 2021. The IGN system used was the easyNav. All patients underwent preoperative computed tomography (CT) scanning and magnetic resonance imaging (MRI) to identify the site of the CSF leak.
Results: The mean age of the patients was 42 years (range, 22-67 years). The most common cause of CSF rhinorrhoea in our study was spontaneous leak (n=12), followed by post-traumatic leak (n=8) and post-operative CSF rhinorrhoea (iatrogenic) (n=6). The most common site of the leak was the cribriform plate, followed by the ethmoid roof, followed by the frontal sinus. The mean operative time was 128 minutes (range, 60-240 minutes). There were no intraoperative complications. Postoperatively, one patient developed meningitis which recovered with antibiotics. All patients had complete resolution of their CSF rhinorrhoea at follow-up.
Conclusion: IGN is a safe and effective technique for the repair of CSF rhinorrhoea. It allows for accurate localization of the leak site and facilitates a minimally invasive approach to the repair.
