González-SánchezJG, Chávez-Velázquez AM, Velázquez-Santana H

Language: Spanish
References: 7
Page: 18-24
PDF size: 342.56 Kb.

ABSTRACT

Background: Cerebrospinal fluid fistula implies the communication with the subarachnoid space by an structural rupture in the base of the skull.
Objective: To describe our experience in the treatment of cerebrospinal fluid fistulae of the anterior and media base of the skull, as well as the applied endoscopic surgical techniques.
Material and method: A retrospective study included 15 patients of the services of Otorhynolaryngology and Neurosurgery of the Regional Hospital Dr. Valentin Gomez Farias, Guadalajara, Jalisco, Mexico, and from the private consultation of authors from August 2008 to December 2010. Diagnosis was made based on two points: the demonstration of rhinorrea and the identification of the precise site of the lesion. Tomographic scans and magnetic resonance images were done and, before the surgery, intratecal fluoresceine was applied. Out of 17 surgeries, 88% (n=15) corresponded to an endoscopic closure and 12%, to intracranial closure.
Results: From 17 surgeries, 15 (88%) were by endoscopic approach, from them, only three cases were associated to meningocele; in two cases it was not possible to find the exact site of fistula, even after the application of intratecal fluoresceine. Transurgical complications were scarce, such as mild bleeding, due to the manipulation of mucosa. Postsurgery complications implied the cerebrospinal fluid fistulae of the media fossa with transmastoid approach. Recidive index was of 12% in the first intention.
Conclusions: The correct diagnosis of cerebrospinal fluid fistulae results in the optimal treatment, in the election of its surgical approach and in the techniques and grafts to be used for the successful closure. The endoscopic surgical approach allows the exact location with the application of intratecal fluoresceine.

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