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
Recep KARAMERTa, İbrahim KUYUMCUa, Mehmet DÜZLÜa, Alper CEYLANa,
Hakan TUTARa, Metin YILMAZa, Yusuf KIZILa, Süleyman CEBECİa, Muammer Melih ŞAHİNa
aGazi Üniversitesi Tıp Fakültesi, Kulak Burun Boğaz Hastalıkları ABD, Ankara, TÜRKİYE
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.
Keywords: Spontaneous cerebrospinal fluid rhinorrhea; encephalocele; intracranial hypertension
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.
Anahtar Kelimeler: Spontan beyin-omurilik sıvısı rinoresi; ensefalosel; intrakraniyal hipertansiyon
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