Cerebrospinal fluids leak from the abnormal communication between the extracranial space and the subarachnoid space. Most of the leaks, as much as 90%, take place at the anterior skull base. The leaks manifest as rhinorrhea and it can become fatal.
One of the major challenges is to recreate the barrier between the nasal cavity and the cranial vault. This is what keeps the cerebrospinal fluid from leaking and prevents the brain from getting exposed to infections. The leaks can cause
intracranial or meningeal infections and further complications. It is very important to repair the leaks.
What is Endoscopic CSF Repair?
The endoscopic repair surgeries have become common and can help to cure patients who have undergone leaks at the anterior skull base. The leaks present difficult challenges for the endonasal endoscopic surgery. The anatomy of the region is very complicated and it becomes technically difficult to access it.
Who are the candidates for Endoscopic CSF Repair?
The patients go through a preoperative evaluation. The history of the patients, especially in relation with previous nasal endoscopies, is checked. The tests include MRI and CT scans, beta-2 transferrin testing and beta-trace testing. These tests confirm CSF rhinorrhea. The tests look for the protein which is almost exclusive in cerebrospinal fluids. If the leakage has stopped, a high-resolution CT scan can do the job.
What is the procedure involved in the Endoscopic CSF Repair?
The size of the fistula and its precise location defines the successful endoscopic closure of the leak. The technique of the closure techniques depends on the location and the size of the cranial defect. There are 3 forms of grafting techniques - overlay, underlay and a combination of them both.
In addition to that, the size of the defects also has a role to play in this matter. While the larger sites (with diameters greater than 3mm) can accommodate the underlay grafts or the multilayer closure with both overlay and underlay grafts, the pliable overlay grafts are suited for the smaller defects. If the defects are very large, a stronger reconstruction might be required. Soft overlay grafts and bony underlay grafts are used with bony countersinking techniques.
What are the success figures for Endoscopic CSF Repair?
The Endoscopic CSF Repair is a minimally invasive technique that has gained popularity in recent years. This is mostly because of the high success rates, which is greater than 95% on an average. The rates of mortality and morbidity are very low.
It has been seen that the endoscopic CSF repair yields a success rate of 90% in the first attempts. The second attempt increases the success rates to a whopping 97%. However, a good workout is necessary for these techniques for better surgical results and avoiding complications.
Authored by Dr Shailesh Pandey, ENT Specialist
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