Endoscopic Endonasal Multilayer Repair Of CSF Rhinorrhea With Utilization Of The Middle Turbinate Rotational Flap

Background: In recent years, many techniques for endoscopic closure of CSF leaks have been described and almost completely replaced the more traumatic transcranial and extracranial procedures. Aim of work: To evaluate endoscopic endonasal multilayer repair of CSF rhinorrhea of anterior and middle cranial fossae utilizing the vascularized middle turbinate rotational flap. Patients and methods: The study included 25 patients who were admitted to the Otorhinolaryngology and Neurosurgery Departments of Zagazig University Hospitals in the period from March 2008 to July 2011. All the patients suffered from CSF leaks of different etiologies with failure of conservative treatment. An endoscopic endonasal multilayer repair utilizing the middle turbinate rotational flap was used for repair of the CSF leak in all patients. Results: This study included 25 patients; 11 females (44%) and 14 males (56%). The age of patients ranged from 17 to 65 years with a mean age of 41 years. The etiology of CSF rhinorrhea was traumatic in 18 patients (72%) and non traumatic in 7 patients (28%). The success rate of endoscopic multilayer repair of CSF rhinorrhea at the first attempt was 92% and with the second attempt increased to 100%. Conclusion: Endoscopic repair of CSF rhinorrhea utilizing the middle turbinate rotational flab provides a better field of vision , accurate positioning of the graft, safe and effective technique with preservation of nasal and neurological function.