E-ISSN: 1019-5157
ISSN: 2651-5024
Research
Surgical Management of Rhinorrhea: Is It Appropriate to Compare Transsphenoidal and Transcranial Approaches? A Single-Center Long-Term Experience
Oguz Altunyuva✉ ,
Nur Balçın ,
Buket Sönmez ,
Rifat Ozpar ,
Pinar Eser ,
Mevlut Ozgur Taskapilioglu ,
Selcuk Yilmazlar
DOI: 10.5137/1019-5149.JTN.49128-25.2
Article in Press
Corresponding Author:
Oguz Altunyuva (dr.oguzaltunyuva@gmail.com)
Abstract
Aim
Anterior skull base cerebrospinal fluid (CSF) fistulas may result in persistent rhinorrhea with a risk of serious infections such as meningitis. In this study, we reviewed our institutional experience and surgical outcomes in patients who underwent repair of anterior fossa CSF fistulas, focusing on the choice of surgical approach.
Material and Methods
We retrospectively analyzed 31 patients who underwent surgery for anterior skull base CSF fistulas. We analyzed demographic characteristics, etiology, fistula location, surgical technique, and recurrence rates.
Results
Of the 31 cases, 20 were traumatic CSF fistulas while 11 were spontaneous. Traumatic fistulas were most frequently located at the cribriform plate (40%), whereas spontaneous leaks were commonly localized to the sphenoid sinus wall (45.4%). A transcranial approach was preferred in 17 traumatic and 7 spontaneous cases, while transsphenoidal surgery was performed in 3 traumatic and 4 spontaneous cases. During a mean follow-up of 88.9 ± 51.5 months, recurrence was observed in 6 cases (19.4%; 4 traumatic, 2 spontaneous). Patients with spontaneous CSF leaks had a significantly higher body mass index than those with traumatic etiologies.
Conclusion
Transcranial and transsphenoidal procedures remain reliable options for the repair of anterior skull base CSF fistulas, when performed by experienced surgeons. Although endoscopic transsphenoidal surgery is commonly favored, transcranial techniquesincluding mini-frontobasal craniotomyshould still be considered in select cases, particularly when anatomical complexity limits endonasal access.
Anterior skull base cerebrospinal fluid (CSF) fistulas may result in persistent rhinorrhea with a risk of serious infections such as meningitis. In this study, we reviewed our institutional experience and surgical outcomes in patients who underwent repair of anterior fossa CSF fistulas, focusing on the choice of surgical approach.
Material and Methods
We retrospectively analyzed 31 patients who underwent surgery for anterior skull base CSF fistulas. We analyzed demographic characteristics, etiology, fistula location, surgical technique, and recurrence rates.
Results
Of the 31 cases, 20 were traumatic CSF fistulas while 11 were spontaneous. Traumatic fistulas were most frequently located at the cribriform plate (40%), whereas spontaneous leaks were commonly localized to the sphenoid sinus wall (45.4%). A transcranial approach was preferred in 17 traumatic and 7 spontaneous cases, while transsphenoidal surgery was performed in 3 traumatic and 4 spontaneous cases. During a mean follow-up of 88.9 ± 51.5 months, recurrence was observed in 6 cases (19.4%; 4 traumatic, 2 spontaneous). Patients with spontaneous CSF leaks had a significantly higher body mass index than those with traumatic etiologies.
Conclusion
Transcranial and transsphenoidal procedures remain reliable options for the repair of anterior skull base CSF fistulas, when performed by experienced surgeons. Although endoscopic transsphenoidal surgery is commonly favored, transcranial techniquesincluding mini-frontobasal craniotomyshould still be considered in select cases, particularly when anatomical complexity limits endonasal access.
Keywords
CSF fistula
rhinorrhea
transsphenoidal
transcranial
skullbase surgery.