A simple and reliable technique for the treatment of rhinoliquorrhoea from small defects: Free nasal mucosa overlay graft

作者：Armengot Miguel^*; Jose Gomez Gomez M; Garcia Lliberos Ainhoa

来源：Neurocirugia, 2013, 24(5): 197-203.

DOI：10.1016/j.neucir.2013.03.002

• Fistula
• Meningitis
• Frontal abscess
• Fluorescein
• Free flap
• Nasal mucosa

Introduction: Cerebrospinal fluid leaks to the sinonasal cavities (rhinoliquorrhoea) represent a process with diagnostic and therapeutic difficulties. The endoscopic transnasal approach is the method of choice, but with many possible variants. The purpose of this paper was to make a critical review of our diagnostic and therapeutic protocol used for 11 years. %26lt;br%26gt;Material and methods: We operated on 31 patients. The diagnosis was based on the bio-chemical analysis of rhinorrhoea, CT and MRI. Treatment: endoscopic nasal surgery after preoperative intrathecal injection of 5% fluorescein (2 cc). Closure was performed using a free overlay graft from middle turbinate mucosa. %26lt;br%26gt;Results: Two patients had meningitis as the first sign. All patients were diagnosed by bio-chemical analysis of rhinorrhoea. CT and MRI gave clear evidence of the leakage location. The skull base defect was always less than 1 cm. Fluorescein allowed clear visualisation of the fistulous area without other instruments and produced no side effects. One patient had a postoperative frontal abscess, which evolved favourably. All fistulas were closed and there was only one recurrence at 10 years, which debuted as pneumococcal meningitis. %26lt;br%26gt;Discussion and conclusions: Our surgical protocol, based on the use of intrathecal fluorescein and free grafting of middle turbinate mucosa overlay onto the fistulous area, achieves successful long-term results in the management of rhinoliquorrhoea secondary to small skull base defects.

• 出版日期2013-10