Endonasal endoscopic repair of anterior skull-base fistulas: The Kuala Lumpur experience

Balwant Singh Gendeh, A. Mazita, B. M. Selladurai, Jegan Thanabalan, J. Jeevanan, K. Misiran

Research output: Contribution to journalArticle

31 Citations (Scopus)

Abstract

The purpose of this retrospective study is to determine the pattern of cerebrospinal fluid (CSF) rhinorrhoea presenting to our tertiary referral centre in Kuala Lumpur and to assess the clinical outcomes of endonasal endoscopic surgery for repair of anterior skull base fistulas. Sixteen patients were treated between 1998 and 2004. The aetiology of the condition was spontaneous in seven and acquired in nine patients. In the acquired category, three patients had accidental trauma and this was iatrogenic in six patients (five post pituitary surgery), with one post endoscopic sinus surgery (ESS). Imaging included computed tomography (CT) scan and magnetic resonance imaging (MRI). Endoscopic repair is less suited for defects in the frontal sinuses with prominent lateral extension and defects greater than 1.5 cm in diameter involving the skull base. Fascia lata, middle turbinate mucosa, nasal perichondrium and ear fat ('bath plug') were the preferred repair materials in the anterior skull base, whereas fascia lata, cartilage and abdominal fat obliteration was preferentially used in the sphenoid leak repair. Intrathecal sodium flourescein helped to confirm the site of CSF fistula in 81.3 per cent of the patients. Ninety per cent of the patients who underwent 'bath plug' repair were successful. The overall success rate for a primary endoscopic procedure was 87.5 per cent, although in two cases a second endoscopic procedure was required for closure. In the majority of cases endoscopic repair was successful, and this avoids many of the complications associated with craniotomy, particularly in a young population. Therefore it is our preferred option, but an alternative procedure should be utilized should this prove necessary.

Original languageEnglish
Pages (from-to)866-874
Number of pages9
JournalJournal of Laryngology and Otology
Volume119
Issue number11
DOIs
Publication statusPublished - Nov 2005

Fingerprint

Skull Base
Fistula
Fascia Lata
Baths
Cerebrospinal Fluid Rhinorrhea
Frontal Sinus
Turbinates
Abdominal Fat
Nasal Mucosa
Craniotomy
Tertiary Care Centers
Cartilage
Ear
Cerebrospinal Fluid
Retrospective Studies
Sodium
Fats
Tomography
Magnetic Resonance Imaging
Wounds and Injuries

Keywords

  • Cerebrospinal Fluid
  • Endoscopic Surgical Procedures
  • Ethmoid Sinus
  • Nasal Cavity
  • Sphenoid Sinus

ASJC Scopus subject areas

  • Otorhinolaryngology

Cite this

Endonasal endoscopic repair of anterior skull-base fistulas : The Kuala Lumpur experience. / Gendeh, Balwant Singh; Mazita, A.; Selladurai, B. M.; Thanabalan, Jegan; Jeevanan, J.; Misiran, K.

In: Journal of Laryngology and Otology, Vol. 119, No. 11, 11.2005, p. 866-874.

Research output: Contribution to journalArticle

Gendeh, Balwant Singh ; Mazita, A. ; Selladurai, B. M. ; Thanabalan, Jegan ; Jeevanan, J. ; Misiran, K. / Endonasal endoscopic repair of anterior skull-base fistulas : The Kuala Lumpur experience. In: Journal of Laryngology and Otology. 2005 ; Vol. 119, No. 11. pp. 866-874.
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