Endoscopic Repair Of Cerebrospinal Fluid Leaks

Cerebrospinal fluid (CSF) surrounds the brain and spine, and is encased in a membrane called the “dura.” If the dura tears, CSF can leak out into the frontal, ethmoid or sphenoid sinuses. If not repaired, a CSF leak can cause serious and potentially fatal complications, including meningitis or swelling of the brain. Endoscopic repair of CSF leaks is far less invasive than open-surgery repair, which requires an incision in the scalp and removing a portion of the skull to access the problem area.

Benefits Of Endoscopic Repair Of Cerebrospinal Fluid Leaks

Using an endoscope, which is a long, thin tube with a light and camera on the end, a surgeon can reach the leak through the nose. This not only makes the patient more comfortable, it offers the physician a magnified, and therefore more detailed, image of the treatment area. Additional benefits to endoscopic repair include less trauma around the treatment site; fewer side effects; and no scarring from facial incisions. Endoscopic repair also reduces the amount of recovery time a patient needs.

Endoscopic Procedure To Repair Cerebrospinal Fluid Leaks

Endoscopic surgery to repair a CSF leak is performed, with the patient under general anesthesia, in a hospital or other medical facility. Special tools are used to remove small quantities of bone, cartilage and mucous membrane from the nose or another part of the body. The bone, cartilage or mucous membrane is then transplanted where necessary between the brain and sinus cavities, creating a layered covering over the damaged area. This repairs the leak and provides protection for the site. Sometimes, a synthetic material is applied to the graft to ensure the leak is properly closed.

In some cases, a drain is inserted to assist with the withdrawal of the fluid. This is done to decrease pressure from the excess CSF and ensure that it is removed from the body. The drain is placed during the procedure to repair the leak, and is taken out before the patient is discharged.

Recovery From Endoscopic Repair Of Cerebrospinal Fluid Leaks

After undergoing CSF repair, patients generally spend a single night in the hospital. However, if a drain is needed, the hospital stay may extend to a few days. The nose is bandaged to contain discharge. Headaches and pain around the nose are common, but they usually respond well to acetaminophen. If not, pain medication is prescribed. Over-the-counter NSAIDs such as aspirin and ibuprofen should be avoided because they can increase bleeding.

Most patients experience significant nasal congestion and minor nosebleeds for 2 to 3 weeks; elevating the head lessens their frequency and discomfort. Saline nasal sprays and sinus-rinse kits keep the sinuses and nasal passages moist, and help in removing debris and reducing congestion. Although walking and other light movement is permitted, patients are advised to wait a week before returning to work and most normal activities. Restrictions may be placed on the lifting of heavy objects and nose-blowing.

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