A 48-year-old female presented with a spontaneous watery discharge from her left nostril for 2 months. Tests showed a cribriform plate leak that was repaired endoscopically. The procedure involved infiltrating and lifting the left nasal concha to create a medial flap, exposing the meningocele, bipolarizing and cauterizing the area, using fat grafts to close the dural defect in layers, and repositioning a mucosal graft. A 62-year-old male who sustained a head injury was also treated endoscopically for a CSF leak from the left sphenoid sinus shown on imaging. Both patients received postoperative antibiotics and acetazolamide.

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

2. CSF Rhinorrhoea Endoscopic Repair
Spontaneous CSF leak Left side
Nose 48 years Female
• 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

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

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

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

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

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

8. 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.

9. 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.

10. CSF Rhinorrhoea Endoscopic Repair
Pneumocephalus
Pneumocephalus

11. 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

12. CSF Rhinorrhoea Endoscopic Repair
• Thank You