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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.
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