This document discusses CSF rhinorrhoea (leakage of cerebrospinal fluid into the nose) and its endoscopic repair. It describes different types of CSF leaks including spontaneous, traumatic, high pressure and low pressure leaks. Radiological tests like CT cisternography and MRI are used to locate the leak site. Endoscopic or transnasal surgical closure of the dural defect is used to manage massive immediate, delayed or spontaneous leaks. The document presents two case studies of endoscopic repair of CSF leaks, one through the cribriform plate and another in the sphenoid sinus. Both cases were successfully treated with infiltration of nasal tissues, exposure and cauterization of the defect, followed by fat graft

1. CSF Rhinorrhoea Endoscopic Repair
Dr Shrikant Phatak
Head of ENT Department
Choithram Hospital & Research Center
Indore

2. CSF Rhinorrhoea
• Drainage of CSF in the nose.
• It can be Spontaneous ,Post Traumatic.
• Spontaneous can be High pressure or Normal
pressure Leaks
• Post Traumatic Leak can be Immediate that is within
48 hours of injury.
• Delayed Leak is after more than 48 hrs. of trauma

3. CSF Rhinorrhoea
• To manage the leak first confirm that leaking
fluid is CSF & not the nasal mucus.
• Locate the site of leak ( breach in the Dura).
• Radiological tests include CT Cisternography
• MRI or a Combo study.
• Massive immediate leaks, Delayed leaks &
Spontaneous leaks require Surgical Closure.
• This can be Endoscopic or Trans Cranial

4. CSF Rhinorrhoea
CSF Leak In Post Ethmoid CSF Leak In Post Ethmoid

5. CSF Rhinorrhoea
Pneumocephalus & Leak Rt Side Right Pneumocephalus

6. CSF Rhinorrhoea Endoscopic Repair
Spontaneous CSF leak Left side
Nose 48 years Female Clinical History
• 48 years old female
presented with
spontaneous watery
discharge left nostril since
2months
• She received Diamox
Antibiotics for 3 weeks
without any relief. This
cribriform plate leak
repaired trans nasally

7. CSF Rhinorrhoea Endoscopic Repair
Infiltrating Left Concha to create
A Flap Creating Medial Flap

8. CSF Rhinorrhoea Endoscopic Repair
Exposing Meningocele
Lateralizing the Concha Bipolarizing the Meningocele

9. CSF Rhinorrhoea Endoscopic Repair
Exposing the Dural Defect Cauterizing Adjacent Areas

10. CSF Rhinorrhoea Endoscopic Repair
Defect Ready for the closure by the Fat
Graft 1 Fat Graft Ready to be pushed in
1st Layer

11. CSF Rhinorrhoea Endoscopic Repair
Fat graft Pushed inside Fat well inside the Defect

12. CSF Rhinorrhoea Endoscopic Repair
Reposting Mucosal graft from
Medial aspect Lt Concha2 & 3 Layers
• Post operative period
• Intravenous Antibiotics
• Acetazolamide 250 mg
thrice daily for 4 weeks.

13. CSF Rhinorrhoea Endoscopic Repair 2nd
Case
• 62 years old male sustained accidental injury
started having massive CSF leak from left side
with Headache.
• X-Ray showed massive Pneumocephalus
• CT cisternography showed leak in the Left
Sphenoid sinus. Repair done trans nasally.

14. CSF Rhinorrhoea
Pneumocephalus
Pneumocephalus

15. CSF Rhinorrhoea
Cisternography Contrast in
Sphenoid Sinus Contrast in Left Sphenoid

16. Disclaimer
• The information contained in the presentation is based on the personal
experience and cases collected at Choithram Hospital Indore over the last
20 years.
• It is intended for the use of Medical students ENT& Neurosurgery post
graduates.
• The views expressed are purely on personal opinion. viewers can make
their own opinion. For any confusion please contact sole author.
• Everybody is allowed to copy or download the material best suited to him.
I am not responsible for any controversies arising out of the presentation.
• For any suggestions or corrections you may please contact
phatak_shrikant@yahoo.in

17. CSF Rhinorrhoea Endoscopic Repair
• Thank You