Management of Traumatic and Non-Traumatic Cerebrospinal Fluid Rhinorrhea—Experience from Three Southeast Asian Countries

Farah Dayana Zahedi (), Somasundaram Subramaniam, Pornthep Kasemsiri, Chenthilnathan Periasamy and Baharudin Abdullah
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Farah Dayana Zahedi: Department of Otorhinolaryngology-Head & Neck Surgery, Faculty of Medicine, Universiti Kebangsaan Malaysia, Kuala Lumpur 56000, Malaysia
Somasundaram Subramaniam: Department of Otolaryngology–Head and Neck Surgery, National University of Singapore, Singapore 119077, Singapore
Pornthep Kasemsiri: Department of Otolaryngology–Head and Neck Surgery, Srinagarind Hospital, Faculty of Medicine, Khon Kaen University, Khon Kaen 40000, Thailand
Chenthilnathan Periasamy: Department of Otorhinolaryngology–Head and Neck Surgery, Penang General Hospital, George Town 10990, Malaysia
Baharudin Abdullah: Department of Otorhinolaryngology–Head and Neck Surgery, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian 16150, Malaysia

IJERPH, 2022, vol. 19, issue 21, 1-14

Abstract: Background: Cerebrospinal fluid (CSF) rhinorrhea requires proper management to avoid disastrous consequences. The objectives of this study were to ascertain the patient characteristics, etiologies, sites of defect, skull base configurations, methods of investigation, and management outcomes of CSF rhinorrhea. Methods: A retrospective study was performed over 4 years involving three surgeons from Malaysia, Singapore, and Thailand. Hospital records were reviewed to determine the patients’ characteristics, the causes and sites of leaks, methods of investigation, skull base configurations, choices of treatment, and outcomes. Results: A total of 15 cases (7 traumatic and 8 non-traumatic) were included. Imaging was performed in all cases. The most common site of leakage was the cribriform plate (9/15 cases). The mean ± SD of the Keros heights were 4.43 ± 1.66 (right) and 4.21 ± 1.76 mm (left). Type II Keros was the most common (60%). The mean ± SD angles of the cribriform plate slope were 51.91 ± 13.43 degrees (right) and 63.54 ± 12.64 degrees (left). A class II Gera configuration was the most common (80%). All except two patients were treated with endonasal endoscopic surgical repair, with a success rate of 92.3%. A multilayered repair technique was used in all patients except one. The mean ± SD postoperative hospital stay was 9.07 ± 6.17 days. Conclusions: Non-traumatic CSF rhinorrhea outnumbered traumatic CSF rhinorrhea, with the most common site of leak at the cribriform plate. Imaging plays an important role in investigation, and Gera classification appears to be better than Keros classification for evaluating risk. Both conservative and surgical repairs are practiced with successful outcomes. Endonasal endoscopic CSF leak repair is the mainstay treatment.

Keywords: cerebrospinal fluid rhinorrhea; cerebrospinal fluid leak; rhinorrhea; skull base; cribriform plate; endoscopic surgical procedure (search for similar items in EconPapers)
JEL-codes: I I1 I3 Q Q5 (search for similar items in EconPapers)
Date: 2022
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