Determining Leak Locations during Transnasal Endoscopic Repair of Cerebrospinal Fluid Rhinorrhea

Objective: It is key in the transnasal endoscopic repair of cerebrospinal fluid rhinorrhea to find leak locations. We explore the relative problems to accurately look for leak locations during the endoscopic repair of cerebrospinal fluid rhinorrhea. Design: Retrospective chart review. Patients/Materials and Methods: The leak locations were determined by preoperative nasal endoscopy, radioisotope scanning, use of an intraoperative image-guided system, and intraspinal normal saline injection in 56 cases undergoing endoscopic repair of cerebrospinal fluid rhinorrhea. Results: Preoperative nasal endoscopy and radioisotope scanning suggested the presence of cerebrospinal fluid from the nasal cavity in 56 cases, from the sphenoidal sinus in 13 cases, from the ethmoid sinus in 122 cases, and from the frontal sinus in 1 case. The leak locations could not be determined in another 15 cases. However, after the ethmoid sinus was thoroughly opened and the lateral wall of the sphenoidal sinus was exposed, with the aid of intraoperative image-guided system, outflow of cerebrospinal fluid was seen on the lateral wall of the sphenoidal sinus in one case and on the ethmoid roof in three cases. Through further intraspinal saline injection (20∼30 mL), leak locations were found in the sphenoidal sinus in four cases and in the ethmoid sinus in eight cases. Conclusion: For patients whose leak locations are difficult to determine, preoperative radioisotope scanning, use of an intraoperative image-guided system, and adequate intraspinal normal saline injection are safe and effective methods to look for leak locations in endoscopic repair of cerebrospinal fluid rhinorrhea, which help establish the basis of surgical success.