Jyotirmay S Hegde
CSF rhinorrhoea indicates an open communication between the intracranial cerebrospinal fluid and the nasal cavity. It can be traumatic and spontaneous. The aim of this study was to assess the outcome of endoscopic repair of cerebrospinal fluid fistula using fluorescein. This retrospective study included 30 patients of both sexes, with a mean age of 44.6 years. All patients underwent lumbar administration of 5% sodium fluorescein solution preoperatively. Fistula was closed using three-layer graft and fibrin glue. Cerebrospinal fluid fistulas were commonly located in the ethmoid (47%) and cribriform plate (23%). Most patients presented with traumatic cerebrospinal fluid fistulas (2/3 of patients). The reported success rate for first attempt repair was 97%. Complications occurred in one patient who presented with acute meningitis. Endoscopic diagnosis and repair of cerebrospinal fluid fistulas using fluorescein intrathecally has high success rate and low complication rate. The arachnoid membrane, dura matter, bone skull base and periosteum, and nasal mucosa layers of the arachnoid membrane, dura matter, and periosteum break down, resulting in CSF rhinorrhoea. Non-traumatic and traumatic CSF leaks are the most common types of persistent CSF leaks. Spontaneous or congenital CSF leaks, as well as leaks induced by intracranial or skull base tumours causing skull base erosion, are non-traumatic causes. Traumatic leaks are more common, and they can be iatrogenic (due to anterior skull base and endoscopic sinus surgery [ESS]) or non-iatrogenic. CSF rhinorrhoea occurs in less than 1% of ESS patients, yet it is a prevalent source of traumatic CSF leak. Clear, unilateral rhinorrhoea is the most common clinical sign of CSF leak, which is aggravated by bending over or executing the Valsalva manoeuvre. The appearance of a headache should trigger suspicions of elevated intracranial pressure or intracranial disease in the doctor. CSF indicators such as Beta-2 transferrin, a sensitive and specific marker, can be used in the lab to confirm the diagnosis. The majority of traumatic CSF leaks will resolve with conservative care, but recurrent CSF leaks will almost always require surgery. Over the last 30 years, the treatment of CSF rhinorrhoea has progressed considerably. Craniotomy was employed for repairs prior to the development of the endoscopic technique, which had a variable success rate and a relatively high morbidity.
