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Cerebrospinal fluid rhinorrhea management

Conclusion This iterative evidence based review demonstrates that the best evidence for managing CSF leaks is based primarily on the surgeon’s preference, taking into consideration both

cost and morbidity. It also confirms that antibiotics and lumbar drains may not be helpful. The overall level of ev idence is relatively poor and we strongly support higher level research to help guide CSF leak repair.

References 1. Eftekhar B, Ghodsi M, Nejat F, Ketabchi E, Es maeeli B. Prophylactic administration of ceftriaxone for the prevention of meningitis after traumatic pneu mocephalus: results of a clinical trial. J Neurosurg . 2004;101:757–761. 2. Eljamel MS, Foy PM. Acute traumatic CSF fistulae: the risk of intracranial infection. Br J Neurosurg . 1990;4:381–385. 3. Friedman JA, Ebersold MJ, Quast LM. Post traumatic cerebrospinal fluid leakage. World J Surg . 2001;25:1062–1066. 4. Hegazy HM, Carrau RL, Snyderman CH, Kassam A, Zweig J. Transnasal endoscopic repair of cere brospinal fluid rhinorrhea: a meta-analysis. Laryngo scope . 2000;110:1166–1172. 5. Bernal-Sprekelsen M, Alobid I, Mullol J, Trobat F, Tomas-Barberan M. Closure of cerebrospinal fluid leaks prevents ascending bacterial meningitis. Rhinol ogy . 2005;43:277–281. 6. Soudry E, Turner JH, Nayak JV, Hwang PH. Endo scopic reconstruction of surgically created skull base defects: a systematic review. Otolaryngol Head Neck Surg . 2014;150:730–738. 7. Harvey RJ, Parmar P, Sacks R, Zanation AM. Endo scopic skull base reconstruction of large dural defects: a systematic review of published evidence. Laryngo scope . 2012;122:452–459. 8. Rudmik L, Smith TL. Development of an evidence based review with recommendations using an on line iterative process. Int Forum Allergy Rhinol . 2011;1:431–437. 9. Oxford Centre for Evidence-based Medicine (CEBM). Levels of Evidence. March 2009. http://www.cebm.net/oxford-centre-evidence-based medicine-levels-evidence-march-2009. Accessed July 28, 2015. 10. Lee TJ, Huang CC, Chuang CC, Huang SF. Transnasal endoscopic repair of cerebrospinal fluid rhinorrhea and skull base defect: ten-year experience. Laryngoscope . 2004;114:1475–1481. 11. van Aken MO, de Marie S, van der Lely AJ, et al. Risk factors for meningitis after transsphenoidal surgery. Clin Infect Dis . 1997;25:852–856. 12. Carrau RL, Snyderman C, Janecka IP, Sekhar L, Sen C, D’Amico F. Antibiotic prophylaxis in cranial base surgery. Head Neck . 1991;13:311–317. 13. Brodie HA. Prophylactic antibiotics for posttrau matic cerebrospinal fluid fistulae. A meta-analysis. Arch Otolaryngol Head Neck Surg. 1997;123:749– 752. 14. Rathore MH. Do prophylactic antibiotics prevent meningitis after basilar skull fracture? Pediatr Infect Dis J . 1991;10:87–88. 15. Villalobos T, Arango C, Kubilis P, Rathore M. Antibi otic prophylaxis after basilar skull fractures: a meta analysis. Clin Infect Dis . 1998;27:364–369. 16. Ratilal BO, Costa J, Sampaio C, Pappamikail L. An tibiotic prophylaxis for preventing meningitis in pa tients with basilar skull fractures. Cochrane Database Syst Rev . 2011;(8):CD004884. 17. Choi D, Spann R. Traumatic cerebrospinal fluid leak age: risk factors and the use of prophylactic antibi otics. Br J Neurosurg . 1996;10:571–575. 18. Eljamel MS. Antibiotic prophylaxis in unrepaired CSF fistulae. Br J Neurosurg . 1993;7:501–505. 19. Clemenza JW, Kaltman SI, Diamond DL. Craniofacial trauma and cerebrospinal fluid leakage: a retrospective clinical study. J Oral Maxillofac Surg . 1995;53:1004– 1007. 20. Banks CA, Palmer JN, Chiu AG, O’Malley BW Jr, Woodworth BA, Kennedy DW. Endoscopic closure of CSF rhinorrhea: 193 cases over 21 years. Otolaryngol Head Neck Surg . 2009;140:826–833. 21. Gilat H, Rappaport Z, Yaniv E. Endoscopic transnasal cerebrospinal fluid leak repair: a 10 year experience. Isr Med Assoc J . 2011;13:597–600. 22. Lanza DC, O’Brien DA, Kennedy DW. Endoscopic re pair of cerebrospinal fluid fistulae and encephaloceles. Laryngoscope . 1996;106(9 Pt 1):1119–1125.

23. Mao VH, Keane WM, Atkins JP, et al. Endoscopic repair of cerebrospinal fluid rhinorrhea. Otolaryngol Head Neck Surg . 2000;122:56–60. 24. White DR, Dubin MG, Senior BA. Endoscopic repair of cerebrospinal fluid leaks after neurosurgical proce dures. Am J Otolaryngol . 2003;24:213–216. 25. Albu S, Emanuelli E, Trombitas V, Florian IS. Effec tiveness of lumbar drains on recurrence rates in en doscopic surgery of cerebrospinal fluid leaks. Am J Rhinol Allergy . 2013;27:e190–e194. 26. Caballero N, Bhalla V, Stankiewicz JA, Welch KC. Effect of lumbar drain placement on recurrence of cerebrospinal rhinorrhea after endoscopic repair. Int Forum Allergy Rhinol . 2012;2:222–226. 27. Casiano RR, Jassir D. Endoscopic cerebrospinal fluid rhinorrhea repair: is a lumbar drain necessary? Oto laryngol Head Neck Surg . 1999;121:745–750. 28. Yeo NK, Cho GS, Kim CJ, et al. The effectiveness of lumbar drainage in the conservative and surgical treatment of traumatic cerebrospinal fluid rhinorrhea. Acta Otolaryngol . 2013;133:82–90. 29. Zuckerman JD, DelGaudio JM. Utility of preoperative high-resolution CT and intraoperative image guidance in identification of cerebrospinal fluid leaks for endo scopic repair. Am J Rhinol . 2008;22:151–154. 30. Ransom ER, Palmer JN, Kennedy DW, Chiu AG. Assessing risk/benefit of lumbar drain use for endo scopic skull-base surgery. Int Forum Allergy Rhinol . 2011;1:173–177. 31. Chaaban MR, Illing E, Riley KO, Woodworth BA. Spontaneous cerebrospinal fluid leak repair: a five-year prospective evaluation. Laryngoscope . 2014;124:70–75. 32. Reh DD, Gallia GL, Ramanathan M, et al. Periopera tive continuous cerebrospinal fluid pressure monitor ing in patients with spontaneous cerebrospinal fluid leaks: presentation of a novel technique. Am J Rhinol Allergy . 2010;24:238–243. 33. Schlosser RJ, Wilensky EM, Grady MS, Bolger WE. Elevated intracranial pressures in spontaneous cerebrospinal fluid leaks. Am J Rhinol . 2003;17: 191–195. 34. Schlosser RJ, Wilensky EM, Grady MS, Palmer JN, Kennedy DW, Bolger WE. Cerebrospinal fluid pres sure monitoring after repair of cerebrospinal fluid leaks. Otolaryngol Head Neck Surg . 2004;130:443– 448. 35. Schlosser RJ, Woodworth BA, Wilensky EM, Grady MS, Bolger WE. Spontaneous cerebrospinal fluid leaks: a variant of benign intracranial hypertension. Ann Otol Rhinol Laryngol . 2006;115:495–500. 36. Chaaban MR, Illing E, Riley KO, Woodworth BA. Acetazolamide for high intracranial pressure cere brospinal fluid leaks. Int Forum Allergy Rhinol . 2013;3:718–721. 37. Woodworth BA, Prince A, Chiu AG, et al. Sponta neous CSF leaks: a paradigm for definitive repair and management of intracranial hypertension. Otolaryn gol Head Neck Surg . 2008;138:715–720. 38. Huang CI, Huang MC, Chen IH, Lee LS. Diverse applications of continuous lumbar drainage of cere brospinal fluid in neurosurgical patients. Ann Acad Med Singapore . 1993;22(3 Suppl):456–458. 39. Ackerman PD, Spencer DA, Prabhu VC. The efficacy and safety of preoperative lumbar drain placement in anterior skull base surgery. J Neurol Surg Rep . 2013;74:1–9. 40. Bhavana K, Kumar R, Keshri A, Aggarwal S. Mini mally invasive technique for repairing CSF leaks due to defects of posterior table of frontal sinus. J Neurol Surg B Skull Base . 2014;75:183–186. 41. Chaaban MR, Conger B, Riley KO, Woodworth BA. Transnasal endoscopic repair of posterior table frac tures. Otolaryngol Head Neck Surg . 2012;147:1142– 1147. 42. Chatrath P, Saleh HA. Endoscopic repair of cere brospinal fluid rhinorrhea using bone pate. Laryngo scope . 2006;116:1050–1053. 43. Citardi MJ, Cox AJ 3rd, Bucholz RD. Acellular der mal allograft for sellar reconstruction after transsphe

noidal hypophysectomy. Am J Rhinol . 2000;14:69– 73. 44. Das PT, Balasubramanian D. Extradural cartilage in lay graft in cerebrospinal fluid fistula repair. J Laryn gol Otol . 2010;124:1294–1297. 45. Demarco RC, Tamashiro E, Valera FC, Anselmo-Lima WT. Use of a hypodense sodium fluorescein solution for the endoscopic repair of rhinogenic cerebrospinal fluid fistulae. Am J Rhinol . 2007;21:184–186. 46. Dodson EE, Gross CW, Swerdloff JL, Gustafson LM. Transnasal endoscopic repair of cerebrospinal fluid rhinorrhea and skull base defects: a review of twenty-nine cases. Otolaryngology Head Neck Surg . 1994;111:600–605. 47. Eloy JA, Choudhry OJ, Friedel ME, Kuperan AB, Liu JK. Endoscopic nasoseptal flap repair of skull base defects: is addition of a dural sealant necessary? Oto laryngology Head Neck Surg . 2012;147:161–166. 48. Eloy JA, Choudhry OJ, Shukla PA, Kuperan AB, Friedel ME, Liu JK. Nasoseptal flap repair after endoscopic transsellar versus expanded endonasal approaches: is there an increased risk of post operative cerebrospinal fluid leak? Laryngoscope . 2012;122:1219–1225. 49. Eloy JA, Kalyoussef E, Choudhry OJ, et al. Salvage endoscopic nasoseptal flap repair of persistent cere brospinal fluid leak after open skull base surgery. Am J Otolaryngol . 2012;33:735–740. 50. Eloy JA, Kuperan AB, Choudhry OJ, Harirchian S, Liu JK. Efficacy of the pedicled nasoseptal flap without cerebrospinal fluid (CSF) diversion for repair of skull base defects: incidence of postoperative CSF leaks. Int Forum Allergy Rhinol . 2012;2:397–401. 51. Eloy JA, Patel SK, Shukla PA, Smith ML, Choudhry OJ, Liu JK. Triple-layer reconstruction technique for large cribriform defects after endoscopic endonasal re section of anterior skull base tumors. Int Forum Al lergy Rhinol . 2013;3:204–211. 52. Eloy JA, Shukla PA, Choudhry OJ, Singh R, Liu JK. Challenges and surgical nuances in reconstruc tion of large planum sphenoidale tuberculum sellae de fects after endoscopic endonasal resection of parasel lar skull base tumors. Laryngoscope . 2013;123:1353– 1360. 53. Farooq MU, Ansari MA. Cerebrospinal fluid rhinor rhea: etiology, site of leakage and endoscopic man agement. J Coll Physicians Surg Pak . 2011;21:460– 463. 54. Garcia-Navarro V, Anand VK, Schwartz TH. Gasket seal closure for extended endonasal endoscopic skull base surgery: efficacy in a large case series. World Neu rosurg . 2013;80:563–568. 55. Germani RM, Vivero R, Herzallah IR, Casiano RR. Endoscopic reconstruction of large anterior skull base defects using acellular dermal allograft. Am J Rhinol . 2007;21:615–618. 56. Horridge M, Jesurasa A, Olubajo F, Mirza S, Sinha S. The use of the nasoseptal flap to reduce the rate of post-operative cerebrospinal fluid leaks following endoscopic trans-sphenoidal surgery for pituitary dis ease. Br J Neurosurg . 2013;27:739–741. 57. Jones V, Virgin F, Riley K, Woodworth BA. Chang ing paradigms in frontal sinus cerebrospinal fluid leak repair. Int Forum Allergy Rhinol . 2012;2:227–232. 58. Kong DS, Kim HY, Kim SH, et al. Challenging re constructive techniques for skull base defect follow ing endoscopic endonasal approaches. Acta Neurochir (Wien) . 2011;153:807–813. 59. Kong YG, Deng YQ, Wang Y. Transnasal endoscopic repair of cerebrospinal fluid rhinorrhea: an analysis of 22 cases. Indian J Otolaryngol Head Neck Surg . 2013;65(Suppl 2):409–414. 60. Landeiro JA, Flores MS, Lazaro BC, Melo MH. Surgical management of cerebrospinal fluid rhinor rhea under endoscopic control. Arq Neuropsiquiatr . 2004;62:827–831. 61. Lorenz RR, Dean RL, Hurley DB, Chuang J, Citardi MJ. Endoscopic reconstruction of anterior and middle cranial fossa defects using acellular dermal allograft. Laryngoscope . 2003;113:496–501.

International Forum of Allergy & Rhinology, Vol. 6, No. 1, January 2016

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