The endoscopic endonasal approach for cerebrospinal fluid leak repair in the elderly

Clinical Neurology and Neurosurgery
Enzo EmanuelliAlessandro Martini

Abstract

Cerebrospinal fluid (CSF) rhinorrhea can lead to CNS infections, carrying significant morbidity and mortality, especially in the elderly. Endoscopic endonasal surgery is a validated technique in the repair of anterior skull base CSF leaks. The aim of this study is to assess diagnostic management, surgical technique and clinical outcome in a consecutive series of elderly patients. Patients older than 65 years treated for anterior skull base CSF leaks through endoscopic endonasal surgery between 2003 and 2014 were retrospectively reviewed. All patients underwent preoperative nasal endoscopy, laboratory and radiological assessment. In doubtful cases endoscopic exploration was performed after intrathecal fluorescein (IF) injection. Patients were discharged between 3 and 4 days after surgery, and the endoscopic follow-up ranged from 3 to 24 months. 20 patients (age range 65-92) presented with 10 spontaneous and 10 traumatic/iatrogenic CSF leaks. In 40% of patients formal rhinoscopy and radiological assessment did not localize the CSF leak and IF injection was performed. IF enabled the identification of the skull base defect in all cases, with no adverse effects. In 11 cases the dura was repaired with fascia lata graft. All patients ...Continue Reading

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Citations

Nov 3, 2017·Laryngoscope Investigative Otolaryngology·Brian C LoboRick F Nelson
Jul 19, 2017·The Journal of Laryngology and Otology·G M OakleyR J Harvey
Jan 1, 2021·Seminars in Plastic Surgery·Weitao WangYadranko Ducic
Oct 13, 2021·World Neurosurgery·Giuseppe E UmanaValentino Valentini

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