ISSN: 1300 - 6525 E-ISSN: 2149 - 0880
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ORIGINAL RESEARCH

Idiopathic Spontaneous Cerebrospinal Fluid Rhinorrhea: Factors Affecting the Results of Endoscopic Repair
İdiyopatik Spontan Beyin Omurilik Sıvısı Rinore: Endoskopik Onarım Sonuçlarını Etkileyen Faktörler
Received Date : 22 Jan 2020
Accepted Date : 28 Feb 2020
Available Online : 11 Mar 2020
Doi: 10.24179/kbbbbc.2020-73715 - Makale Dili: TR
KBB ve BBC Dergisi. 2020;28(1):57-63
Copyright © 2020 by Turkey Association of Society of Ear Nose Throat and Head Neck Surgery. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/)
ABSTRACT
Objective: Evaluation of clinical presentations of idiopathic spontaneous cerebrospinal fluid (CSF) rhinorrhea patients and determining the factors affecting the results of endoscopic surgery. Material and Methods: Eighteen patients who underwent endoscopic surgery due to idiopathic spontaneous CSF rhinorrhea in our clinic between November 2013-March 2019 were included in the study. Archieved data was scanned and the effects of parameters such as demographic characteristics, graft material used, lumbar drainage and fluorescein application on surgical success were evaluated. Results: All 18 patients included in the study were women. The age of the patients ranged from 30-68 (mean: 47.2). The CSF fistula originated from the ethmoid roof in 10 (55.5%) patients, and the sphenoid sinus in 8 (44.5%) patients. Rhinorrhea recurred in 2 (11.1%) patients after the first surgery. After revision surgery, rhinorrhoea was taken under control in all patients. Among the evaluated parameters, only application of a middle turbinate flap was associated with the surgical outcome (negatively) (p=0.003). Localization of the defect, presence of encephalocele, preferred graft material, application of fibrin sealant, or postoperative lumbar drainage did not have a significant effect on the results. One of the patients experienced a seizure at the postoperative second day and the reason was thought to be lumbar drainage. Conclusion: Idiopathic spontaneous CSF rhinorrhea is often seen in middle-aged women. The success rate with endoscopic surgery is high regardless of the graft material and adjunctive applications used. Serious complications may rarely be seen after surgery.
ÖZET
Amaç: İdiyopatik spontan beyin omurilik sıvısı (BOS) rinore hastalarının klinik prezantasyonlarının değerlendirilmesi ve tedavide uygulanan endoskopik cerrahinin sonuçlarını etkileyen faktörlerin saptanmasıdır. Gereç ve Yöntemler: Çalışmaya, Kasım 2013-Mart 2019 tarihleri arasında idiyopatik spontan BOS rinore tanısıyla kliniğimizde endoskopik BOS rinore onarımı yapılan 18 hasta dâhil edildi. Arşiv bilgileri taranarak hastaların demografik özellikleri, kullanılan greft materyali, lomber drenaj ve fluoresein uygulaması gibi parametrelerin cerrahi başarı üzerine etkileri değerlendirildi. Bulgular: Çalışmaya dâhil edilen 18 hastanın tümü kadındı. Hastaların yaş aralığı 30-68 yıl idi (ortalama: 47,2). BOS fistülü 10 (%55,5) hastada etmoid çatıdan, 8 (%44,5) hastada ise sfenoid sinüsten kaynaklanıyordu. İlk cerrahi sonrası 2 (%11,1) hastada rinore tekrarladı. Revizyon cerrahi sonrası hastaların tümünde rinore kontrol altına alındı. Değerlendirilen parametrelerden sadece orta konka flepi ile onarımın cerrahi sonuçla ilişkisi (olumsuz yönde) olduğu görüldü (p=0,003). Defekt lokalizasyonu, ensefalosel varlığı, kullanılan greft materyali, fibrin doku yapıştırıcı kullanımı ya da postoperatif lomber drenajın sonuçlar üzerine anlamlı bir etkisi olmadığı saptandı. Bir hastada postoperatif 2. günde epilepsi atağı görüldü ve sebebin lomber drenaj olduğu düşünüldü. Sonuç: İdiyopatik spontan BOS rinore sıklıkla orta yaşlı kadınlarda görülmektedir. Endoskopik cerrahi ile başarı oranı kullanılan greft materyalinden ve yardımcı uygulamalardan bağımsız olarak yüksektir. Cerrahi sonrası nadiren de olsa ciddi komplikasyonlar görülebilir.
KAYNAKLAR
  1. Bernal-Sprekelsen M, Bleda-Vázquez C, Carrau RL. Ascending meningitis secondary to traumatic cerebrospinal fluid leaks. Am J Rhinol. 2000;14(4):257-9. [Crossref]  [PubMed] 
  2. Mincy JE. Posttraumatic cerebrospinal fluid fistula of the frontal fossa. J Trauma. 1966;6(5):618-22. [Crossref]  [PubMed] 
  3. Beckhardt RN, Setzen M, Carras R. Primary spontaneous cerebrospinal fluid rhinorrhea. Otolaryngol Head Neck Surg. 1991;104(4): 425-32. [Crossref]  [PubMed] 
  4. Ommaya AK, Di Chiro G, Baldwin M, Pennybacker JB. Non-traumatic cerebrospinal fluid rhinorrhoea. J Neurol Neurosurg Psychiatry. 1968;31(3):214-25. [Crossref]  [PubMed]  [PMC] 
  5. Hubbard JL, McDonald TJ, Pearson BW, Laws ER Jr. Spontaneous cerebrospinal fluid rhinorrhea: evolving concepts in diagnosis and surgical management based on the Mayo Clinic experience from 1970 through 1981. Neurosurgery. 1985;16(3):314-21. [Crossref]  [PubMed] 
  6. Wise SK, Schlosser RJ. Evaluation of spontaneous nasal cerebrospinal fluid leaks. Curr Opin Otolaryngol Head Neck Surg. 2007;15(1):28-34. [Crossref]  [PubMed] 
  7. Dunn CJ, Alaani A, Johnson AP. Study on spontaneous cerebrospinal fluid rhinorrhoea: its aetiology and management. J Laryngol Otol. 2005;119(1):12-5. [Crossref]  [PubMed] 
  8. Schlosser RJ, Bolger WE. Nasal cerebrospinal fluid leaks: critical review and surgical considerations. Laryngoscope. 2004;114(2):255-65. [Crossref]  [PubMed] 
  9. Stibler H. The normal cerebrospinal fluid proteins identified by means of thin-layer isoelectric focusing and crossed immunoelectrofocusing. J Neurol Sci. 1978;36(2):273-88. [Crossref] 
  10. Lanza DC, O'Brien DA, Kennedy DW. Endoscopic repair of cerebrospinal fluid fistulae and encephaloceles. Laryngoscope. 1996;106(9 Pt 1):1119-25. [Crossref]  [PubMed] 
  11. Zweig JL, Carrau RL, Celin SE, Schaitkin BM, Pollice PA, Snyderman CH, et al. Endoscopic repair of cerebrospinal fluid leaks to the sinonasal tract: predictors of success. Otolaryngol Head Neck Surg. 2000;123(3):195-201. [Crossref]  [PubMed] 
  12. Dilci A, Ceylan A, Kızıl Y, Yılmaz M, Uslu S, İleri F. [Endoscopic cerebral spinal fluid (CSF)-rhinorrhea-our clinical experiences]. Gazi Medical Journal. 2015;26(4):191-3.
  13. Kirtane MV, Gautham K, Upadhyaya SR. Endoscopic CSF rhinorrhea closure: our experience in 267 cases. Otolaryngol Head Neck Surg. 2005;132(2):208-12. [Crossref]  [PubMed] 
  14. Castelnuovo P, Mauri S, Locatelli D, Emanuelli E, Delù G, Giulio GD. Endoscopic repair of cerebrospinal fluid rhinorrhea: learning from our failures. Am J Rhinol. 2001;15(5):333-42. [Crossref]  [PubMed] 
  15. McMains KC, Gross CW, Kountakis SE. Endoscopic management of cerebrospinal fluid rhinorrhea. Laryngoscope. 2004;114(10): 1833-7. [Crossref]  [PubMed] 
  16. Badia L, Loughran S, Lund V. Primary spontaneous cerebrospinal fluid rhinorrhea and obesity. Am J Rhinol. 2001;15(2):117-9. [Crossref]  [PubMed] 
  17. Kerr JT, Chu FW, Bayles SW. Cerebrospinal fluid rhinorrhea: diagnosis and management. Otolaryngol Clin North Am. 2005;38(4):597-611. [Crossref]  [PubMed] 
  18. Zapalac JS, Marple BF, Schwade ND. Skull base cerebrospinal fluid fistulas: a comprehensive diagnostic algorithm. Otolaryngol Head Neck Surg. 2002;126(6):669-76. [Crossref]  [PubMed] 
  19. Lloyd MN, Kimber PM, Burrows EH. Post-traumatic cerebrospinal fluid rhinorrhoea: modern high-definition computed tomography is all that is required for the effective demonstration of the site of leakage. Clin Radiol. 1994;49(2): 100-3. [Crossref] 
  20. Sillers MJ, Morgan CE, el Gammal T. Magnetic resonance cisternography and thin coronal computerized tomography in the evaluation of cerebrospinal fluid rhinorrhea. Am J Rhinol. 1997;11(5):387-92. [Crossref]  [PubMed] 
  21. Shetty PG, Shroff MM, Sahani DV, Kirtane MV. Evaluation of high-resolution CT and MR cisternography in the diagnosis of cerebrospinal fluid fistula. AJNR Am J Neuroradiol. 1998;19(4):633-9.
  22. Keerl R, Weber RK, Draf W, Wienke A, Schaefer SD. Use of sodium fluorescein solution for detection of cerebrospinal fluid fistulas: an analysis of 420 administrations and reported complications in Europe and the United States. Laryngoscope. 2004;114(2): 266-72. [Crossref]  [PubMed] 
  23. Mattox DE, Kennedy DW. Endoscopic management of cerebrospinal fluid leaks and cephaloceles. Laryngoscope. 1990;100(8): 857-62. [Crossref]  [PubMed] 
  24. Hegazy HM, Carrau RL, Snyderman CH, Kassam A, Zweig J. Transnasal endoscopic repair of cerebrospinal fluid rhinorrhea: a meta-analysis. Laryngoscope. 2000;110(7):1166-72. [Crossref]  [PubMed] 
  25. Lund VJ. Endoscopic management of cerebrospinal fluid leaks. Am J Rhinol. 2002;16(1):17-23. [Crossref]  [PubMed] 
  26. Schick B, Ibing R, Brors D, Draf W. Long-term study of endonasal duraplasty and review of the literature. Ann Otol Rhinol Laryngol. 2001;110(2):142-7. [Crossref]  [PubMed] 
  27. Casiano RR, Jassir D. Endoscopic cerebrospinal fluid rhinorrhea repair: is a lumbar drain necessary? Otolaryngol Head Neck Surg. 1999;121(6):745-50. [Crossref]  [PubMed] 
  28. Roland PS, Marple BF, Meyerhoff WL, Mickey B. Complications of lumbar spinal fluid drainage. Otolaryngol Head Neck Surg. 1992;107(4):564-9. [Crossref]  [PubMed]