Endoscopic Endonasal Repair of Cerebrospinal Fluid Rhinorrhea by The Combined Overlay and Underlay Techniques

26 J Kor Neurotraumatol Soc Cerebrospinal fluid (CSF) rhinorrhea involves a breakdown of all barriers that separate the subarachnoid space from the upper aerodigestive tract, namely, the mucosa of the nasal cavity or paranasal sinus, skull base, dura mater, and arachnoid membrane. CSF rhinorrhea expressed as meningitis, subdural empyema or brain abscess, when inadequately treated 3,19) . CSF fistulas can be classified into traumatic and non-traumatic: the traumatic group can be classified in accidental and iatrogenic 16) . The non-traumatic group is related with brain tumors, congenital skull base defect and meningoceles or meningoencephaloceles. Conservative treatment is based on bed rest, lumbar punctures and permanent spinal fluid diversion. The surgical treatment of a CSF fistula is controversial as it depends on the etiology of leak and the location of the fistula 15) . Surgical repair consists of transcranial approaches or nasal approaches with the use of an endoscope 1,3,19) . The success rate of transcranial approaches ranged from 60 90%. In recent years, endoscopic methods for the repair of CSF fistula are considered to be the treatment of choice for CSF rhinorrhea repair 9,15) . The advantages associated with the use of an endoscope better lighting, magnification of the image and best angle visualization give the surgeon a more precise diagnosis and a less invasive method of treatment 11,14,17,23) . The aim of this study is to determine the efficacy of endoscopic transnasal repair of cerebrospinal fluid rhinorrhea and skull base defect by the combined overlay and underlay techniques.