Transnasal endoscopic repair of adult spontaneous cerebrospinal fluid rhinorrhea with assistance of computer-assisted navigation system: an analysis of 21 cases

Abstract

The purpose of this study was to investigate and summarize the characteristics of spontaneous cerebrospinal fluid rhinorrhea cases and the efficacy of transnasal endoscopic repair of spontaneous cerebrospinal fluid rhinorrhea with the assistance of computer-assisted navigation system. This is a retrospective study including 21 adult patients with spontaneous cerebrospinal fluid rhinorrhea who underwent transnasal endoscopic repair with the assistance of computer-assisted navigation system between January 2007 and December 2017. Data collected included patient demographics, body mass index, patient symptoms, biochemical findings, radiographic findings, location of defect, type and size of defect, type of repair, follow-up time, reoccurrence, and complications. Spontaneous cerebrospinal fluid rhinorrhea was more commonly seen in females who were middle-aged and overweight in our series. The effluent was determined as cerebrospinal fluid by testing of glucose concentration and β2-transferrin. The location of the lesion was determined by rigid nasal endoscopy combined with radiologic study. Intraoperatively, the skull base defects were found most frequently on the ethmoid roof in 12 cases (57.1%), followed by the cribriform plate in seven cases (33.3%), and sphenoid sinus in two cases (9.5%). The size of the skull base defect was\u2009<\u20095 mm in 13 cases, 5 mm\u2009~\u200910 mm in six cases and two cases involved defects of\u2009≥\u200910 mm. The graft materials were chosen based on the size of the defect. In small leaks, the thigh muscle was dumbbell-shaped herniated into the bony defect, reinforced by fascia lata. Larger defects were packed with the anterior part of middle turbinate with an overlay of fascia lata. All 21 patients had no recurrence of cerebrospinal fluid rhinorrhea during the follow-up period, which ranged from 11 to 24 months. The transnasal endoscopic approach with assistance of computer-assisted navigation system is a safe and effective procedure for the repair of spontaneous cerebrospinal fluid rhinorrhea.