Neuroendoscopic Repair Of Traumatic Cerebrospinal Fluid Rhinorrhea

Objective:To explore diagnosis positioning method and the surgical procedure of transnasal neuroendoscopic repair of traumatic cerebrospinal fluid rhinorrhea (CFR).Methods:A retrospective analysis was made on the clinical data of 22 cases with traumatic CFR repaired by neuroendoscopy from December 2010 to December 2013. The details were recorded:age,sex,injury causes, time of CFR, location of rhinorrhea fistulas, size, materials for repair, method of repair,curative effect and follow-up result, etc. By high resolution CT(HRCT) examination preoperatively, combined with the cerebral MRI or CT cisternography(CTC), we confirmed location and size of the fistulas.the locations of rhinorrhea fistulas:ethmoid sinus(6 cases), saddle bottom(3 cases), sieve plate(4 cases), sphenoid sinus(3 cases), posterior wall of frontal sinus (3 cases), more than two leaks (3 cases), fistulas size:> 15 mm (5 cases),5 mm-15 mm (11 cases),< 5 mm(6 cases). It should choose proper type of surgery according to specific disease states, materials:artificial dura mater, thigh fascia lata, muscle, temporal fascia,pedicle mucosal flap.Methods:attached method and tamping method,repair material placed were placed tightly closely,covered with gelatin sponge,we tamped nasal cavity with article iodoform gauze.Patients stayed in bed for 20-30 ° head high, were used broad-spectrum antibiotics to prevent infection, maintained the bowel movement is unobstructed, avoided strenuous physical activity and did not hold your breath etc.Patients with high intracranial pressure need brain CT and measuring intracranial pressure,patients with hydrocephalus performance shoud be taken lumbar cistern drainage or ventricular drainage.Results:CFR was repaired successfully during the first attempt in 21 of 22 cases,21 patients were follwed up for 8 to 24 months postoperatively,and none of them had recurrence during this period.One suffered from intracranial infection and acute obstructive hydrocephalus,this case auto-discharge.Conclusion:Transnasal neuroendoscopic repair of traumatic CFR shoud be the first choice of operative method for traumatic CFR because of its minimal invasion and high successful rate. Neuroendoscopy has fine lighting,equips with mult-angle lens, so it can display fistula clearly. Transnasal endoscopy avoids opening craniotomy and retracting brain tissue and intracranial important structure,so surgeons can directly operates on anterior skull base. The key points:the location of rhinorrhea fistulas, the materials for repair, method of repair,Properly handled can improve the success rate of operation.