الفهرس Only 14 pages are availabe for public view
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Abstract
CSF rhinorrhea involves a breakdown of all barriers that separate the subarachnoid space from the nasal cavity or paranasal sinuses. The etiology of CSF rhinorrhea is diverse. CSF rhinorrhea from the anterior cranial fossa may occur after head trauma, ablative tumor surgery, or surgery for paranasal sinus inflammatory disease. Although the incidence of a CSF fistula after endoscopic sinus surgery (ESS) is less than 1%, ESS is a common cause of CSF fistulae. Blunt trauma to the head is another frequent cause of CSF leaks, which are diagnosed in 3% of all patients with a closed head injury and in up to 30% of patients who have skull base fractures. Conditions that increase the ventricular pressure, such as intracranial tumors and post-traumatic and post-infectious hydrocephalus are also important causes of CSF leaks. In addition, arachnoid granulations present along the cribriform plate may also lead to spontaneous CSF rhinorrhea.
This essay aimed to review the aetiology of CSF rhinorrhoea, methods of its diagnosis and to discuss the different CSF rhinorrhoea surgeries, their techniques, advantages and disadvantages.
The most important factor in the detection of CSF rhinorrhea is a low threshold of suspicion and this often arises from the history. Any case of unilateral watery rhinorrhea, particularly if increased by posture, should not be empirically treated with intranasal corticosteroids but requires further investigation. It is difficult to identify a leak on routine endoscopic examination, but allows the clinician to formulate a differential diagnosis and may identify an intranasal encephalocele.
The management of cerebrospinal fluid (CSF) leaks has been a controversial topic from many points of view.