(1227) Review of Endoscopic Repair of Cerebrospinal Fluid Rhinorrhea: 104 Cases Over Eight Years

Introduction: CSF rhinorrhea stems from traumatic and non-traumatic factors. Endoscopic repair, employing various techniques and grafts/flaps, is the preferred approach. Our objective is a comprehensive review within our institution, assessing outcomes and recurrence rates tied to our specific techniques.

Methods: This is a comprehensive chart review study. Subjects were patients with CSF rhinorrhea operated on by the senior author at Cleveland Clinic Abu Dhabi between August 2015 to August 2023. The following variables were included: etiology, defect site, surgical approach, graft/flap types, lumbar drain usage, meningitis occurrences, increased intracranial pressure, and overall outcomes, including recurrence based on the last clinic visit.

Results: A total of 104 cases were identified. Follow-up was ranging from 1 month to 5 years (mean 8.87 months). The majority 68/104 (65.38%) had iatrogenic cerebrospinal fluid (CSF) leaks post-endoscopic skull base surgery/pituitary surgery, followed by spontaneous CSF leaks 29/104 (27.88%), and post-traumatic 7/104 (6.73%). The female-to-male ratio was 54/50. Patients showing signs of intracranial hypertension were 21/104 (20.19%). In terms of location, 66/104 (63.46%) had a sphenoid defect, 30/104 (28.85%) had an ethmoid defect, while clivus, frontal, and floor of middle cranial fossa defects were observed in 4/104 (3.85%), 2/104 (1.92%), and 1/104 (0.96%) of cases, respectively. Of these, 64/104 (61.54%) were repaired using a vascularized pedicled flap (middle turbinate or septal), and 40/104 (38.46%) with a graft. Overall success rate was 95%, with a 4.81% recurrence rate. No recurrences were observed in spontaneous and traumatic cases, while iatrogenic cases had a 7.35% recurrence rate.

Conclusions: In conclusion, our comprehensive examination underscores the efficacy of our procedures with a notable success rate. The identified recurrence rate emphasizes the need to consider multiple factors during repairs, crucial for optimizing overall outcomes in CSF rhinorrhea interventions.