الفهرس 
INTRODUCTIONOnly 14 pages are availabe for public view
 |  | from | 125 |  |  |
| | | from | 125 | | |
Abstract
Surgical repair of cerebrospinal fluid rhinorrhea includes transcranial (craniotomy) or extracranial (nasal) approaches which includes external ethmoidectomy, endonasal ethmoidectomy and endoscopic endonasal approach.
Endoscopic endonasal techniques have emerged as the preferred approach to the repair of skull base defects. This approach provides excellent exposure of the ethmoid roof, cribriform plate, and the sphenoid sinus, in addition to its several advantages, including excellent visualization and identification of the defect as well as graft placement, better lightning, magnification of the image and best angle visualization, which gives the surgeon a more precise diagnosis and a less invasive method of nasal CSF fistula treatment, giving the endoscopic surgery a status of the method of treatment choice.
The aim of this work is to study endonasal endoscopic repair of skull base in patients with CSF rhinorrhea as regards technical aspects, limitations, results, complications and applicability to various anatomical and pathological variables CSF leak conditions.
This prospective study included fifty five patients with CSF rhinorrhea due to different causes. All were operated endoscopic endonasally.
All patients had complete history taken, complete general and neurological examination, and an informed consent was signed for each patient. Preoperatively, all patients had routine laboratory investigations; multislice thin cuts computed tomography (CT scan) and/or magnetic resonance imaging (MRI) of the brain, paranasal sinuses and skull base. Postoperatively, endoscopic examination; CSF manometry, computed tomography (CT scan) and/or magnetic resonance imaging (MRI) of the brain and paranasal sinuses were done when needed.
Objective surgical data were obtained. It included the surgical time; materials used for repair, type of repair and estimated blood loss. Postoperative assessment was done immediately postoperative, 1 week, 4 weeks, 3 months 6 months and 12 months later. All patients were subjected to revising the preoperative symptoms. Patients with spontaneous leak were subjected to endoscopic examination and delayed lumbar puncture for measuring opening CSF pressure.
This study included 55 cases, included 37 (67.27%) females and 18 (32.73%) males, with mean age of 36.67±14.30 years. All cases presented with CSF rhinorrhea, headache in 69.1% of cases, 35(63.6%) were spontaneous CSF rhinorrhea, 14(25.5%) were post-operative (Iatrogenic) CSF leak, and 6(10.9%) were post-traumatic.
The present study included 8 (14.5%) patients had persistent CSF leak during the early postoperative period (within 1-2 months) following endoscopic endonasal repair and required further management. Three of these cases were re-operated endoscopically with successful closure of the defect and cure of the condition. One case with disturbed anatomy required open craniotomy through intracranial route using pericranial flap repair of the anterior skull base. The remaining 3 cases with recurrent CSF leaks due to persistent increased CSF pressure were resolved after insertion of lumbar peritoneal shunt for increased CSF pressure in the follow up. Single endoscopic endonasal repair was successful in preventing CSF leak in 47 (85.5%) patients. Following repeat endoscopic repair in additional cases the su