تدبير سيلان السائل الدماغي الشوكي عبر الأنف بالتنظير

الملخص EN

Background& Objective: Management of CSF rhinorrhea by an effective and less traumatic endoscopic tans-nasal approach in comparison with traditional open craniotomy one.

Objective: To study cases of CSF rhinorrhea and to evaluate the results of Endoscopic trans-nasal repair and failure rates.

Materials & Methods: Retrospective study of 34 cases (first main group) of meningeal nasal fistula admitted to Al Moassate university hospital between 5.2004 - 5.2009 in addition to three cases in which the fistula had occurred during an endoscopic sinus surgery (second secondary group).

Results: In the first group the main presenting complain was persistent or intermittent clear watery rhinorrhea in 30 patients (88.23%), history of repeated Meningitis in 4 patients (11.76%) and rhinorrhea and one episode of meningitis in one patients (2.94%).A history of head trauma was detected in 20 patients (58.82%), nasal surgery in 4 patients (11.76%), where no history of head trauma or nasal surgery was found in 10 patients (29.41%).

The fistula situated in the roof of the ethmoid sinus in 28 patients (79.41%), roof or lateral wall of sphenoid sinus in 4 patients(11.76%), and in the roof of both ethmoid and sphenoid sinuses in tow patients(5.88%).

The fistula was closed by endoscopic trans-nasal approach with fascia latta in 31 patients (83.78%), fascia of rectus abdominalis in one patient and with the mucoperostium of contra-lateral inferior turbinate in 5 patients (13.51%).

Follow-up was for 12-43 months.

Recurrence has occurred in 10 patients (27.02%) in a form of recurrence of watery rhinorrhea or recurrence of meningitis or both of them.

Second endoscopic trans-nasal intervention had done in 8 of them, second recurrence occurred in 3 patients.

Thus the overall success rate was (91.42%).

Conclusion: Endoscopic trans-nasal approach is an effective way to repair the meningeal nasal fistulas with low morbidity and mortality rate in comparison with the traditional open neurosurgery approach.