TRANSCRANIAL DURAL REPAIR;

EFFICACY IN THE MANAGEMENT OF EARLY TRAUMATIC CEREBROSPINAL FLUID RHINORRHEA.

Abstract

Objectives: To determine efficacy of transcranial dural repair in management
of early traumatic cerebrospinal fluid (CSF) rhinorrhea by measuring the rate of resolution of
rhinorrhea following repair. Material and Study Design: Descriptive study. Period: 18 months
from March 2014 to September 2015. Setting: Department of Neurosurgery Naseer Teaching
hospital Peshawar. Methods: 30 patients, all head injury patients with CSF rhinorrhea of either
gender and any age, reporting to Accident and emergency department were included in the
study. MRI Brain T2 Weighted in prone position done in all cases to identify the dural rent.
Transcranial intradural repair was done through subfrontal approach. Post op complications
were documented and follow at two months. Results: In this study 30 patients with cerebrospinal
fluid (CSF) leak were observed. The minimum age was 8 years and the maximum was 59 years.
23 (76.6%) were male and 7 (23.3%) were female. 18 (60%) patients have CSF rhinorrhea due
to road traffic accident, 7 (23.3%) patient with history of fall, while 5 (6.6%) patient were in other
category. MRI brain T-2 Weighted done in all patient to identify the dural defect. The surgical
approach was intradural in all of the 30 (100%) patients having fascia lata graft in 28 (93.3%)
patients and pericranium in 2 (7%) patients to cover the defect properly. Among the immediate
complications 3 (10%) patients had recurrent CSF leak, 2(6.6%) had meningitis, 5 (16.6%)
had Pneumoencephalus while 3(10%) patients had other complications like subarachnoid
hemorrhage, wound infection etc. The overall success rate was 90%. Conclusion: It is
concluded that in post traumatic cerebrospinal fluid (CSF) rhinorrhea, if the defect in dura is
demonstrated it must be repaired as soon as possible in order to prevent fulminant meningitis.