Sinonasal cerobrospinal fluid leak endoscopic repair, local experience

Abstract

Introduction: The treatment of sinonasal cerebrospinal fluid leak (CSFL) can be conser- vative or surgical, with endoscopic repair being the gold standard. Objective: To describe the experience of Hospital Barros Luco Trudeau (HBLT) in the endoscopic sinonasal CSFL repair over the past 20 years. Material and Method: A retrospective descriptive study was conducted, reviewing medical records of patients who underwent endoscopic sinona- sal CSFL repair at HBLT from 2003 to 2023. Variables analyzed included demographic, clinical presentation, complementary studies, repair technique, follow-up, recurrence, and postoperative complications. Results: A total of 22 cases were identified. The most com- mon symptoms were unilateral rhinorrhea and headache. The most frequent etiologies were spontaneous (45.5%) and iatrogenic (32%). Defects were located in the ethmoid (63.5%), sphenoid (32%), and frontal (4.5%) sinuses. Intrathecal fluorescein was used in 8 patients. All cases were repaired using a multilayer closure technique, with an average of 2 grafts per patient, primarily middle turbinate mucosa (54.5%), DuraGen® (50%), and septal cartilage (41%). Hemostatic materials and/or sealants were also used. Postope- ratively, 64% of patients received acetazolamide. The average follow-up period was 14.8 ± 8.5 months. Four cases (18%) presented recurrence at 20 months of follow-up. There were no significant differences in CSFL recurrence between groups with and without in- trathecal fluorescein or postoperative acetazolamide use. One case (4.5%) presented with pneumocephalus as a complication. Conclusion: Endoscopic repair of sinonasal CSFL is an effective technique with low rates of recurrence and postoperative complications. In HBLT’s experience, there were no differences in outcomes based on the use of intrathecal fluorescein or acetazolamide.