The Key Role of Packing Technique for Successful Endoscopic Repair of CSF Rhinorhea

Abstract Background: Spontaneous CSF leaks are rare, their diag-nosis is often delayed, and they can precipitate meningitis. Craniotomy and intracranial approach is the historical "gold standard" repair for these leaks [1]. Anendonasal endoscopic approach offers potentially less invasiveness and lower surgical morbidity than a traditional craniotomy but must yield the same surgical success [2]. Recurrence of these leaks is not uncommon. One of the most important factors of this recur-rence is inadequate support of the flaps or grafts or loose cooptation of raw surfaces which may be unable to resist the normotensive CSF leak. Maintaining adequate continuous low grade pressure intraoperativelyand two weeks post-operatively may optimize the best chance for raw areas to heal properly with minimal recurrence. Aim of Study: The aim of this study is to identify and discuss the pivotal role of intraoperative packing and its technique to obtain a successful repair of CSF rhinorrhea. Patients and Methods: A prospective randomized study conducted on 14 patients suffering spontaneous CSF rhinor-rhea, from March 2018 to April 2020 in Hearing and Speech Institute. The 14 patients have been divided into two equal groups 7 patients each, group A and group B. In group A, traditional nasal packing was done, whoever, in group B, the special packing was done in the form two packs, the first pack over the grafted area was two layered composed of 1mm thickness silasticsheet over the graft and raw area and a piece of Merocel 1 by 1.5cmms supporting the silastic sheet. The second pack was placed in the nasal cavity. The first pack has been changed weekly to two or three weeks then removed finally. Results: All patients were doing well throughout the follow-up period. In group A, there was recurrence in fourpa-tients, two after six months and two after one year. In group B there was one recurrence after one year of follow-up.
Abstract Background: Spontaneous CSF leaks are rare, their diag-nosis is often delayed, and they can precipitate meningitis. Craniotomy and intracranial approach is the historical "gold standard" repair for these leaks [1]. Anendonasal endoscopic approach offers potentially less invasiveness and lower surgical morbidity than a traditional craniotomy but must yield the same surgical success [2]. Recurrence of these leaks is not uncommon. One of the most important factors of this recur-rence is inadequate support of the flaps or grafts or loose cooptation of raw surfaces which may be unable to resist the normotensive CSF leak. Maintaining adequate continuous low grade pressure intraoperativelyand two weeks post-operatively may optimize the best chance for raw areas to heal properly with minimal recurrence. Aim of Study: The aim of this study is to identify and discuss the pivotal role of intraoperative packing and its technique to obtain a successful repair of CSF rhinorrhea. Patients and Methods: A prospective randomized study conducted on 14 patients suffering spontaneous CSF rhinor-rhea, from March 2018 to April 2020 in Hearing and Speech Institute. The 14 patients have been divided into two equal groups 7 patients each, group A and group B. In group A, traditional nasal packing was done, whoever, in group B, the special packing was done in the form two packs, the first pack over the grafted area was two layered composed of 1mm thickness silasticsheet over the graft and raw area and a piece of Merocel 1 by 1.5cmms supporting the silastic sheet. The second pack was placed in the nasal cavity. The first pack has been changed weekly to two or three weeks then removed finally. Results: All patients were doing well throughout the follow-up period. In group A, there was recurrence in fourpa-tients, two after six months and two after one year. In group B there was one recurrence after one year of follow-up.