CSF Rhinorrhea – A Rivulet from the Skull Base – Otolaryngologist’s Perspective in Endoscopic Repair – Role of Tissue Glue in ‘Titanic Trickles

Abstract

Introduction: Endonasal endoscopic CSF leak repair has now become the primary modality of management for patients with CSF rhinorrhea. The aim of this article is to emphasise on the factors responsible for the success of the surgery and the advantages of using fibrin/tissue glue in closure CSF leak defects. Materials & Methods: A retrospective study was done on a group of 10 patients diagnosed with CSF rhinorrhea who have been surgically managed with endonasal endoscopic multilayered CSF leak repair with the help of tissue glue (fibrin glue/sealant). All 10 patients were reviewed regularly postoperatively over a period of 1 year, in order to assess the success in closure of the defect and to assess the recurrence rate in case of failed closure.
Results: Out of 10 patients, 7 had CSF leakage from left nasal cavity, 2 from right nasal cavity, 1 from both nasal cavities. 90 % of the study population was female, 10 % male. Among the 10 patients, 7 had spontaneous CSF leaks (1 associated with idiopathic intracranial hypertension) and 3 were post traumatic. Multilayered leak repair approach was utilized in all the cases which significantly reduces the chances of recurrences and fibrin glue expresses adhesive sealant property that is one of the most important factors contributing to the success of surgery, especially in cases with leaks associated with idiopathic intracranial hypertension.
Conclusion: Multilayered closure involving 3 or more layers and the usage of fibrin glue proves to be an excellent augmentative adhesive sealant especially in cases with multiple sites of leak and/or in spontaneous leak with idiopathic intracranial hypertension.