REPAIR OF CSF LEAKS
ENDOSCOPIC REPAIR OF CSF LEAKS
Cerebrospinal fluid (CSF) surrounds the brain and is encased within a membrane known as the dura. Sometimes, due to a severe facial bone fracture, surgical complication or another form of trauma, a patient may develop a CSF leak. A leak occurs when there is a tear in the dura and sometimes a defect in the bone, allowing the fluid to enter the frontal, ethmoid or sphenoid sinuses.
The typical symptoms are watery, clear drip usually from either the right or left nostril especially on leaning forward. A headache may be associated with it and is more painful when you are upright and feels better when you are lying down. It may also be accompanied by nausea, photosensitivity and a stiff neck, all of which may suggest that an meningeal infection is present. In order to diagnose a CSF leak, your doctor will obtain information on your medical history, complete a physical examination and take a sample of the fluid for analysis. Additional tests may be performed as well, including an MRI or CT scan.
Surgical repair is often necessary to resolve the CSF leak. If it is not repaired, serious complications such as meningitis or swelling of the brain may arise, which can be fatal. Traditional surgery to repair a CSF leak involves making an incision in the scalp and removing a portion of the skull to access the problem area. Endoscopy has vastly improved this procedure and made it far less invasive.
By using an endoscope, which is a long, thin tube with a light and camera on the end, the Otolaryngologist can approach the leak through the nose. This not only makes the patient more comfortable and reduces the recovery period, but it also offers the physician a magnified—and therefore more detailed—image of the treatment area during the procedure. Additional benefits to performing the repair endoscopically include that it results in less trauma around the treatment site, the risk of side effects is lower and no incisions are made on the face, so there is no chance of scarring.
The Endoscopic CSF Leak Repair Procedure
Endoscopic surgery to repair a CSF leak is performed in a hospital or other medical facility with the patient under general anesthesia. The surgeon will use special tools to remove small quantities of bone, cartilage and mucous membrane from the nose or another part of the body. These tissues will then be transplanted to the defective area between the brain and sinus cavities. They are used to create a layered covering over the defect, repairing the leak and providing protection to the site. In some cases, a drain must be inserted in the back (called lumbar drain) to allow the leak to seal. This is done to decrease pressure from the excess CSF. The drain can be placed during the leak repair procedure and will be taken out before the patient is discharged.
Recovery from an Endoscopic CSF Leak Repair Procedure
After undergoing this procedure, patients are generally required to spend one or more nights in the hospital. However, if a drain was needed, the hospital stay may be extended to a few days. Headaches and pain around the nose are very common after a CSF leak procedure, but they usually respond well to acetominephin. Over-the-counter NSAIDs such as aspirin and ibuprofen should be avoided immediately after the surgery as they can increase bleeding.
Most patients experience significant nasal congestion and minor nose bleeds for two to three weeks following the repair procedure. Keeping the head in an elevated position can lessen the frequency and discomfort of these common side effects. Saline nasal sprays and sinus rinse kits are often very helpful in keeping the sinuses and nasal passages moist, removing debris and reducing congestion too.
While walking and other light activity is permitted, patients are typically advised to wait one week before returning to work and most normal activities. Your doctor will discuss any restrictions to follow, which usually include limitations on lifting heavy objects and refraining from blowing your nose.