The fluid located in the spaces within the brain and spinal cord and between the membranes surrounding these structures is called "cerebrospinal fluid (CSF). Under normal conditions, CSF, which is a clear liquid that does not contain microorganisms, should remain within the brain membrane, which consists of different layers, and should not have contact with the external environment. The strongest and most protective layer of the membrane structure surrounding the brain and spinal cord is the outermost layer called Dura. Leakage of CSF into the external environment due to damage to the Dura for various reasons is called CSF leak or CSF fistula, and a clear discharge from the nose as a result of this leakage into the nose and surrounding sinus cavities is called "Rhinorrhea".
In addition to the close proximity between the brain and nasal-sinus cavities, the fact that the bone wall between these anatomical structures is very thin and fragile in some areas increases the risk of CSF leakage in these areas. The passage of microorganisms in the nose and sinuses, which are not a sterile environment, into the brain membranes from the damaged area can cause very serious complications such as inflammation of the meninges (meningitis), inflammation of the brain tissue (encephalitis) or abscess formation in the brain. Fractures in the brain membrane (Dura layer) and adjacent bone structures as a result of blows,
Involuntary traumas that occur during surgical interventions in areas adjacent to the Dura, especially endoscopic sinus surgeries,
Traumas in areas adjacent to the Dura. Mostly malignant tumors,
Intentionally occurring openings during surgeries for tumors and masses adjacent to the dura,
Congenitally found weak points, openings, and anatomical variations in the bone structures surrounding the dura are the most common causes of CSF leakage. CSF leaks, which cannot be detected and are called spontaneous, may also occur.
How is CSF Leak Diagnosed?
In all patients, especially those with a history of head trauma or surgery in the nose and sinus area, clear fluid leaks from the nose unilaterally and worsen with bending forward and straining. The presence of discharge should bring to mind the possibility of a CSF leak.
In patients with sinus surgery, endoscopic examination of the surgical site Although scopic evaluation helps in diagnosis, the definitive diagnosis can be made by laboratory analysis of the clear fluid flowing from the nose. Once the diagnosis is finalized, the leak area must be identified in order to plan the treatment. For this purpose, various radiological evaluations, especially computed tomography and MRI, are performed. In cases where the leak area cannot be determined by standard imaging techniques, this detection may need to be made by intranasal endoscopic examination by administering special dyes into the CSF.
How Are CSF Leaks Treated?
In order to stop the CSF leak, the damage to the brain membrane must be repaired in a watertight manner.
For this repair, in the past years, an approach was applied from the outside by opening a window in the skull bones, but today, especially following the development of endoscopic sinus surgery technology, it is first applied through the nose. Interventions performed are preferred.
During the surgery, the damaged area is visualized with endoscopes from inside the nose, and then small tissue pieces such as fat, cartilage, bone lamella, fascia are obtained from the patient's nose or body, and special equipment is used when necessary. By using tissue adhesives, repair can be achieved without causing serious additional damage outside the intervention area.
Read: 0
