Microscopic Transnasal Repair of Cerebrospinal Fluid Rhinorrhea by Free Autologous Inlay and Onlay Grafts with Middle Turbinate Reinforcement Techniques

Abstract The aim of the study is to determine the efficacy of microscopic transnasal repair of cerebrospinal fluid (CSF) rhinorrhea with free autologous inlay and onlay grafts combined with reinforcement techniques using middle turbinate and to compare the result with endoscopic repair. A total of 19 patients with spontaneous CSF rhinorrhea were included in this study. There were 11 males and 8 females. Their age ranged from 38 to 70 years (mean 51.42). The etiology of the leak was spontaneous in all cases. Preoperative computed tomography (CT), magnetic resonance imaging (MRI), and CT cisternography were done. Microscopic repair of the CSF fistula was done using the combination of inlay and onlay free autologous grafts, reinforced with a composite middle turbinate pedicled graft. Complete closure of the leak was achieved in all patients. In one case, CSF leak persisted postoperatively for 2 days which stopped with conservative medical treatment and therapeutic spinal tap. No major complications were seen and no patients developed meningitis or postoperative anosmia. Microscopic transnasal repair of CSF rhinorrhea by free autologous inlay and onlay grafts with middle turbinate reinforcement techniques is a safe and successful method of treating CSF rhinorrhea and can be performed safely by neurosurgeons who are not trained for endoscopic surgery.