Peng Anquan, Li Youzhong, Xiao Zian, Wu Weijing
Department of Otorhinolaryngology-Head & Neck Surgery, The Second Xiangya Hospital of Central South University, Changsha 430011, Hunan, China.
Int J Pediatr Otorhinolaryngol. 2011 Mar;75(3):308-15. doi: 10.1016/j.ijporl.2010.11.016. Epub 2010 Dec 8.
To summarize the clinical manifestations of pediatric cerebrospinal fluid rhinorrhea (CSFR), discuss the localization of CSFR, and the surgical approaches, the graft material selection and the prognoses of endoscopic repair of CSFR.
The case data, surgical techniques and graft materials of endonasal endoscopic approach of 43 patients with CSFR who have been treated at the Second Xiangya Hospital, Central South University in the last 13 years were retrospectively analyzed. Among them, leaks in 34 cases were from the roof of the ethmoid sinuses. Other sites included frontal sinus (1), sphenoid sinus (6), and the conjunction of ethmoid and frontal sinuses (2). 37 patients were with unilateral CSF leaks, 6 were with bilateral CSF leaks. The dimensions of the defects ranged between 8 and 22mm. For 25 cases, the procedure was as follows: first, the wound surrounding the perimeter of the defect was freshened and the leaks were plugged by myoplasm and overlaid with iliac fascia, and followed by the use of fibrin glue and nasal packing; for 5 cases, the procedure was as follows: at first, the wound was curetted and the leaks were intracranially plugged by autologous cartilage and muscle, overlaid with iliac fascia, followed by the use of fibrin glue and nasal packing; for 6 cases, the leaks were overlaid with iliac fascia only, and then fibrin and packing were used. For the rest of 7 cases, the frontal and sphenoid sinuses were filled with muscle.
Of the total 43 cases, 31 had successful closure of the leaks by endonasal endoscopic repair on first attempt; 8 had successful closure of the leaks on second attempt, 3 was cured on third attempt; while, leaks in 2 patients failed to close after three attempts. Therefore, they underwent combined intracranial and transnasal endoscopic repair, one patient was cured and another one died postoperatively because of recurrent intracranial infection. At 12 month to 24 month follow-up 42 children remained leak free.
Endoscopic repair of CSF leaks is the optimum approach to the treatment of pediatric CSFR, featuring minor trauma, high successful rate, fewer complications and advantage of being able to carry out a revision surgery or more if needed. For children who have a large CSF leak in size and have failed to be treated successfully via endonasal endoscopic repair, combined intracranial and endoscopic repair could be performed to close the leak.
