Our surgical approach to idiopathic CSF rhinorrhea

Objectives: This study aims to evaluate the efficacy of endoscopic endonasal surgery in patients with idiopathic cerebrospinal fluid (CSF) rhinorrhea. Patients and Methods: In this study, 24 patients (8 males, 16 females; mean age: 52.8±12.0 years; range, 18 to 72 years) who underwent endonasal endoscopic surgery for idiopathic CSF rhinorrhea were retrospectively analyzed between January 2009 and May 2018. Pediatric patients and patients with a history of trauma, tumor, or previous cranial and endoscopic endonasal surgery were excluded from the study. Patients’ demographic characteristics, defect localization, side, size, radiological features, graft/flap materials used, additional treatment methods, and complications were analyzed. Results: When the defect localization was examined, 33.4% was the sphenoid sinus lateral wall , 25.0% of olfactory sulcus region, 20.8 posterior of frontal sinüs ostium and %20.2 fovea ethmoidalis. One patient had a bilateral defect. On radiological examination, more than half of the patients (54.2%) were Keros type 2. Defect size ranged from at least 1 mm to at most 20 mm. Postoperative hospital stay was between 6 days and 60 days. Eleven of the patients had lumbar drainage. Fascia lata was most commonly (66.6%)used to close the defect. Complications encountered were meningitis, pneumocephalus, and sepsis; mortality occurred in one patient. One patient underwent craniotomy due to recurrent rhinorrhea. Conclusion: Despite the difficulties in diagnostic methods, advances in medical technology and surgical techniques have enabled the minimally invasively treatment of idiopathic CSF rhinorrhea using endoscopic methods. Contrary to external approaches, endonasal endoscopic method is an effective treatment method with low morbidity and mortality.