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

Abstract

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 11years.

Material and methods: We operated on 31patients. The diagnosis was based on the biochemical analysis of rhinorrhoea, CT and MRI.

Treatment: endoscopic nasal surgery after preoperative intrathecal injection of 5% fluorescein (2cc). Closure was performed using a free overlay graft from middle turbinate mucosa.

Results: Two patients had meningitis as the first sign. All patients were diagnosed by biochemical analysis of rhinorrhoea. CT and MRI gave clear evidence of the leakage location. The skull base defect was always less than 1cm. 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 10years, which debuted as pneumococcal meningitis.

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.

Keywords: Absceso frontal; Colgajo libre; Fistula; Fluorescein; Fluoresceína; Free flap; Frontal abscess; Fístula; Meningitis; Mucosa nasal; Nasal mucosa.