Role of Conservative Treatment and Outcome of Traumatic CSF Rhinorrhea

Main Article Content

Amjad Ali Shah
Iram Bokhari
Rabail Akbar
Tanweer Ahmed
Faizyab Ahmed
Anas Ahmed

Abstract

Background: Traumatic cerebrospinal fluid (CSF) rhinorrhea, a rare but serious consequence of head injuries, poses significant challenges in diagnosis and management. Understanding the efficacy of treatment modalities is crucial to improve patient outcomes and reduce complications.


Objective: This study aims to evaluate the effectiveness of conservative versus surgical treatment in managing traumatic CSF rhinorrhea and to identify factors influencing treatment outcomes.


Methods: A descriptive case series was conducted at Jinnah Postgraduate Medical Center, Karachi, from September 2022 to February 2023. Thirty patients with traumatic CSF rhinorrhea, aged 18-60 years, were included. Data on patient demographics, site of CSF leakage, management approach, and recovery were collected. Diagnostic methods involved glucose oxidase test strips and imaging techniques. Statistical analysis was performed using SPSS version 23.


Results: Of the patients, 73.3% were male, and 26.7% were female. CSF leakage sites included the sphenoid sinus (36.7%), frontal sinus (33.3%), ethmoidal sinus (20.0%), and cribriform plate (10.0%). Conservative treatment controlled 80% of CSF rhinorrhea cases within 48 hours. Surgical intervention was necessary in 20% of cases, primarily for persistent leaks. The mean age of patients was 40.67±10.54 years.


Conclusion: The study indicates that conservative management is effective in the majority of traumatic CSF rhinorrhea cases. However, surgical intervention remains crucial for cases unresponsive to initial treatment. These findings highlight the need for individualized treatment plans and suggest further research into optimizing management strategies for traumatic CSF rhinorrhea.

Article Details

How to Cite
Shah, A. A., Bokhari , I., Akbar, R., Ahmed, T., Ahmed, F., & Ahmed , A. (2023). Role of Conservative Treatment and Outcome of Traumatic CSF Rhinorrhea. Journal of Health and Rehabilitation Research, 3(2), 741–746. https://doi.org/10.61919/jhrr.v3i2.225
Section
Articles
Author Biographies

Amjad Ali Shah, Jinnah Postgraduate Medical Centre Karachi.

Postgraduate Trainee, Neurosurgery Department.

Iram Bokhari , Jinnah Postgraduate Medical Centre Karachi.

Associate Professor Neurosurgery Department.

Rabail Akbar, Jinnah Postgraduate Medical Centre Karachi.

Consultant Neurosurgeon, Neurosurgery Department.

Tanweer Ahmed, Jinnah Postgraduate Medical Centre Karachi.

Consultant Neurosurgeon, Neurosurgery Department.

Faizyab Ahmed, Jinnah Postgraduate Medical Centre Karachi.

Consultant Neurosurgeon, Neurosurgery Department.

Anas Ahmed , Jinnah Postgraduate Medical Centre Karachi.

Postgraduate Trainee, Neurosurgery Department.

References

Farooq MU, Ansari MA. Cerebrospinal fluid rhinorrhea: etiology, site of leakage and endoscopic management. J Coll Physicians Surg Pak. 2011;21(8):460-3.

Altaf I, Vohra AH, Shams S. Management of cerebrospinal fluid leak following posterior cranial fossa surgery. Pakistan Journal of Medical Sciences. 2016;32(6):1439.

Banks CA, Palmer JN, Chiu AG, O'Malley Jr BW, Woodworth BA, Kennedy DW. Endoscopic closure of CSF rhinorrhea: 193 cases over 21 years. Otolaryngology-Head and Neck Surgery. 2009;140(6):826-33.

Bobeff EJ, Posmyk BJ, Bobeff K, Fortuniak J, Wiśniewski K, Stawiski K, et al. Predicting outcome and conservative treatment failure in patients with skull fracture after traumatic brain injury: a retrospective cohort study. Journal of Neurological Surgery Part A: Central European Neurosurgery. 2019;80(06):460-9.

Chae R, Jung DH, Chari DA. Management of cerebrospinal fluid leak following lateral skull base trauma. Otologic and Lateral Skull Base Trauma: Elsevier; 2024. p. 133-47.

Choi D, Spann R. Traumatic cerebrospinal fluid leakage: risk factors and the use of prophylactic antibiotics. British journal of neurosurgery. 2006;10(6):571-6.

Dalgic A, Okay H, Gezici AR, Daglioglu E, Akdag R, Ergungor M. An effective and less invasive treatment of post-traumatic cerebrospinal fluid fistula: closed lumbar drainage system. min-Minimally Invasive Neurosurgery. 2008;51(03):154-7.

Eide JG, Kohanski MA. Conservative and Medical Therapy for Cerebrospinal Fluid Leaks. Skull Base Reconstruction: Management of Cerebrospinal Fluid Leaks and Skull Base Defects: Springer; 2023. p. 83-92.

Smaija S, Fatima N, Shahid L, Shahid A. The Management options for Post Traumatic CSF Rhinorrhea: A Case Series study. Pakistan Journal Of Neurological Surgery. 2022;26(1):76-82.

Oh J-W, Kim S-H, Whang K. Traumatic cerebrospinal fluid leak: diagnosis and management. Korean journal of neurotrauma. 2017;13(2):63-7.

Lewin W. Cerebrospinal fluid rhinorrhea in nonmissile head injuries. Neurosurgery. 2006;12(CN_suppl_1):237-52.

Ekici NY, Bayar Muluk N, Bellussi LM. Rhinorrhea: Treatment. Airway diseases: Springer; 2023. p. 1-10.

Georgalas C, Oostra A, Ahmed S, Castelnuovo P, Dallan I, van Furth W, et al., editors. International consensus statement: spontaneous cerebrospinal fluid rhinorrhea. International Forum of Allergy & Rhinology; 2021: Wiley Online Library.

Khan R, Sajjad M, Khan AA, Ahmad B, Ahmad S, Mushtaq M, et al. Comparison of lumbar drain insertion and conservative management in the treatment of traumatic CSF rhinorrhoea. Journal of Ayub Medical College Abbottabad. 2019;31(3):441-4.

La Russa R, Maiese A, Di Fazio N, Morano A, Di Bonaventura C, De Matteis A, et al. Post-traumatic meningitis is a diagnostic challenging time: a systematic review focusing on clinical and pathological features. International journal of molecular sciences. 2020;21(11):4148.

Mahmood RZ, Lakho MA, Abbas T, Wajid A, Ahmed T, Farooq U, et al. Results of Conservative Management of CSF Rhinorrhea in Post Traumatic Patients. Pakistan Journal Of Neurological Surgery. 2022;26(2):258-62.

Mikayilli M, Hasanov T, Otluoglu GD, Nacitarhan DE, Erdogan RBA, Demir N, et al. Spontaneous idiopathic cerebrospinal fluid rhinorrhea. Journal of Craniofacial Surgery. 2019;30(7):2265-7.

Qazi R, Rehman L, Ahmed T, Qazi SA, Afzal A. The Frequency of Early Post Traumatic Cerebrospinal Fluid Rhinorrhea in Patients with Head Trauma. Pakistan Journal Of Neurological Surgery. 2022;26(2):250-7.

Ramakrishnan N, Roy R, Singh S, Goyal S, Gupta D, Chugh R. Approach to Management of Cerebrospinal Fluid Rhinorrhea: Institutional Based Protocol. Indian Journal of Otolaryngology and Head & Neck Surgery. 2022:1-8.

Raval H. Study of Management of Cerebrospinal Fluid Rhinorrhea. Indian Journal of Neurosurgery. 2021;11(03):221-5.

Raykar R. Clinical profile, management and outcome of patients with head injury associated CSF rhinorrhea at a tertiary care centre. Medica. 2020;9(2):41.

Tajelsir M, Elfadil N, Elawad M. Management and outcome of treatment modalities of cerebrospinal fluid rhinorrhea. Pan Arab Journal of Rhinology. 2020;10(2):63.

Vamanshankar H, Hegde JS. Traumatic CSF rhinorrhea. CSF Rhinorrhoea: Management and Practice. 2020:23-30.

Vasu ST, Krishnamoorthy V, Karunakaran S, Pillay HM. A Comparative Analysis of Transcranial and Endoscopic Repair for Traumatic CSF Rhinorrhea. Journal of Neurological Surgery Part A: Central European Neurosurgery. 2023;84(05):428-32.