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European Archives of Oto-Rhino-Laryngology

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01-10-2018 | Rhinology

Spontaneous nasal cerebrospinal fluid leaks: management of 24 patients over 11 years

Authors: Anna S. Englhard, Veronika Volgger, Andreas Leunig, Catalina S. Meßmer, Georg J. Ledderose

Published in: European Archives of Oto-Rhino-Laryngology | Issue 10/2018

Abstract

Purpose

Most cases of non-traumatic nasal cerebrospinal fluid (CSF) leaks occur spontaneously without any obvious reason. Severe and life-threatening complications are possible consequences. Endoscopic repair is considered the gold standard; however, diagnosis and therapy of these CSF leaks stay challenging.

Methods

In this retrospective analysis, patients who presented with spontaneous nasal CSF leaks from 2006 to 2017 were included. Symptoms, diagnostics, localization of the skull base defect, surgical method, outcome, and postoperative treatment were recorded.

Results

Twenty four patients were included. 8 patients presented with symptoms of meningitis. The skull base defects were most commonly located in the anterior ethmoid roof—especially in the cribriform plate—and in the lateral part of the sphenoid sinus. 21 patients had a BMI above 25. In only 13 cases the defect could be detected preoperatively via computed tomography or additional magnetic resonance imaging. In all patients intraoperative visualization of the CSF leak was possible using intrathecal application of sodium-fluorescein. Endoscopic repair was the initial surgical method for all patients and proved to be successful in 80% of the cases. In most cases surgical revision was performed endoscopically; however, in two patients an open transpterygoidal approach was necessary.

Conclusions

Spontaneous nasal CSF leaks often initially present with symptomatic meningitis. Imaging does not always clearly identify the skull base defect. Common localizations are the anterior ethmoid roof and the lateral sphenoid sinus. Obesity seems to be a predisposing factor. In most cases, endoscopic repair with low morbidity is possible; however, an individualized approach is necessary.

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Title: Spontaneous nasal cerebrospinal fluid leaks: management of 24 patients over 11 years
Authors: Anna S. Englhard
Veronika Volgger
Andreas Leunig
Catalina S. Meßmer
Georg J. Ledderose
Publication date: 01-10-2018
Publisher: Springer Berlin Heidelberg
Published in: European Archives of Oto-Rhino-Laryngology / Issue 10/2018
Print ISSN: 0937-4477
Electronic ISSN: 1434-4726
DOI: https://doi.org/10.1007/s00405-018-5089-y

At a glance: The STEP trials

Springer Medicine

Spontaneous nasal cerebrospinal fluid leaks: management of 24 patients over 11 years

Abstract

Purpose

Methods

Results

Conclusions

At a glance: The STEP trials

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusions

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