[Surgical management of cerebrospinal fluid rhinorrhea].

OBJECTIVE: To summarize the clinical experience in managing cerebrospinal fluid (CSF) rhinorrhea. To ascertain the best effective surgical management for CSF rhinorrhea. METHODS: A retrospective study of 83 patients with CSF rhinorrhea from March 1991 to August 2001 was conducted. Among them, 17 patients were treated with conservative therapy, 8 with transcranial repair, 2 with extranasal repair, 3 with transnasal repair under microscope and 54 with transnasal endoscopic management. The conservative time, causes, complications, leak sites, repairing materials and surgical methods were analysed. RESULTS: All patients were followed -up for 6 months to 9 years. 17 cases had no CSF rhinorrhea after conservative treatment with an average time 16 days. Endoscopic repair of CSF leaks was successful in 90% (49/54) of the cases after a first attempt. Two persistent leaks (2/4) were closed after a second attempt. The other persistent leaks were also closed, one case after third and one after fourth attempt. Ultimately 98% (53/54) of the leaks were repaired using an endoscopic approach. Only one failed after transendoscopic management, and succeeded with a second extranasal repair. The CSF rhinorrhea repaired with other surgical methods were all successful. CONCLUSION: Transnasal endoscopic management is the best method for repairing CSF rhinorrhea, other surgical methods can be chosen based on different conditions. The conservative time are 2 to 4 weeks if a CSF leak is caused by trauma or operation, 6 to 8 weeks conservative time for special cases.