THE SUCCESS AND COMPLICATIONS OF ENDOSCOPIC ENDONASAL MULTI-LAYER TECHNIQUE FOR THE MANAGEMENT OF SPONTANEOUS CEREBROSPINAL FLUID (CSF) RHINORRHEA

Objective: To determine the success and complications of endoscopic endonasal multi-layer technique for the management of spontaneous cerebrospinal fluid (CSF) rhinorrhea Materials and Methods: This descriptive chart review was conducted at Khyber Teaching Hospital and involved thirty-four patients with spontaneous CSF rhinorrhea confirmed by MRI. Exclusions included trauma, previous surgery, and tumors. The primary outcome was the success rate of the endoscopic endonasal approach and associated complications. Patients underwent endoscopic repair under general anesthesia. Postoperative care included strict bed rest, prophylactic antibiotics, and regular follow-up evaluations. Results: The participants had a mean age of 37 ± 14.3 years, with a female predominance (67.65%). The mean BMI was 28 ± 3.6, with 74% of patients having a BMI over 25. Preoperative imaging identified the cribriform plate as the most frequent leak site (64.71%). The most common complication was meningocele (5.8%). One patient had idiopathic intracranial hypertension (2.9%). All patients underwent successful endoscopic endonasal multi-layer repair, achieving a 97.06% success rate. Postoperative complications included nasal crusting (14.71%), sinusitis (11.76%), and a brief postoperative CSF leak (2.94%), which resolved spontaneously. One patient required a secondary repair. Follow-ups at one and three months confirmed the durability of the repairs, with no recurrence of CSF leaks. Conclusion: The endoscopic technique is effective for managing spontaneous CSF rhinorrhea, demonstrating a high success rate with minimal complications. These findings support minimally invasive approaches in CSF leak management, emphasizing the importance of patient demographics and comorbidities in treatment planning. Keywords: CSF Rhinorrhea, Endoscopic repair, Endoscopic endonasal multi-layer technique