Yusuf KIZIL, Alper DİLCİ, Fikret İLERİ, Sabri USLU, Metin YILMAZ, Alper CEYLAN

Endoskopik Beyin Omurilik Sıvısı (BOS) - Rinore Onarımı - Klinik Deneyimlerimiz

Amaç: Beyin Omurilik Sıvısı (BOS) Rinorenin endoskopik olarak onarımı konusundaki deneyimlerimizi ve önerilerizi paylaşmaktır. Yöntem: Retrospektif olarak 2004 - 2014 yılları arasında Gazi Üniversitesi Kulak Burun Boğaz Kliniği'nde tedavi edilen 30 hastada BOS rinore nedeni, defektin yeri ve büyüklüğü, onarım şekli, rekürrensin araştırılmasıdır. Bulgular: BOS Rinore nedeniyle endoskopik olarak opere edilen 30 hastanın 19 tanesi travmatik ve 11 tanesi non - travmatik nedenlere bağlıdır. İyatrojenik nedenlerle BOS rinore ile sonuçlanan 6 hastanın yarısı hipofiz cerrahisi sonucu oluşmuştur. Hastaların % 20 sinin başvuru öncesinde menenjit öyküsü mevcuttur. Defekt yeri en sık sfenoid sinüs, ethmoid çatı ve frontal recess bölgesindedir. Endoskopik onarım yapılan 3 hastada nüks görülmüştür. Sonuç: BOS Rinore; endoskopik sinüs cerrahisi, endoskopik intrakraniyel işlemler ve ön kafa tabanı cerrahisinin sıklaşması sonrası KBB hekimleri tarafından sıkla karşılaşılan bir durum olmaya başlamıştır.Uygun tanı metotları ve endoskopik yaklaşımlarla başarılı sonuçlara ulaşılabilmektedir

Endoscopic Cerebral Spinal Fluid (CSF) - Rhinorrhea - Our Clinical Expreriences

Objective: We shared our experience of endoscopic repair of cerebrospinal fluid (CSF) rhinorrhea. Methods A retrospective study of 30 patients with CSF rhinorrhea managed endoscopically from 2004 - 2014 in ENT Department of Gazi University. The cause of CSF rhinorrhea, localization and size of the defect, repairstyle, recurrence have been investigated. Results: Etiologically, 19 patients are traumatic and 11 patients are non traumatic. Six patients are caused by iatrogenically and half of them are caused by hypophysectomy. 20 % of patients have a history of meningitis before admission to our clinic. Sphenoid sinus, ethmoid roof and frontal recess are the most seen regions of the defects. There was recurrence in 3 patients endoscopically managed. Conclusion: Because of the advance of endoscopic sinus surgery, endoscopic intracranial procedures and anterior skull base surgery; CSF Rhinorrhea could come across frequently by ENT surgeons. Successful results could be obtained by appropriate management and endoscopic techniques.

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Zapalac JS, Marple BF, Schwade ND. Skull base cerebrospinal fluid fistulas: a comprehensive diagnostic algorithm.Otolaryngol Head Neck Surg.2002;126:669- 76.
Zweig JL, Carrau RL, Celin SE,et al.Endosccopic repair of cerebrospinal fluid leaks to the sinonasal tract: predictors of success.Otolaryngol Head Neck Surg.2000;123:195-201.
Hegazy HM,Carrau RL, Snyderman CH,et al.Transnasal endoscopic repair of cerebrospinal fluid rhinorrhea: ameta -analysis. Laryngoscope.2000; 110:1166-72. 4. Nandapalan V, Watson ID, Swift AC. Beta-2-transferrin and cerebrospinal fluid rhinorrhoea. Clin Otolaryngol.1996;21:259-64.
Giovannetti Endoscopic endonasal approaches for cerebrospinal fluid leaks repair. J Craniofac Surg. 2013;24:548-53.
Banks CA, Palmer JN, Chiu AG, O'Malley BW Jr, Woodworth BA, Kennedy DW. Endoscopic closure of CSF rhinorrhea: 193 cases over 21 years. Otolaaryngol Head Neck Surg 2009;140:826-33.
Psaltis AJ, Schlosser RJ, Banks CA, Yawn J, Soler ZM. A systematic review of the endoscopic repair of cerebrospinal fluid leaks. Otolaryngol Head Neck Surg 2012;147:196-203.
Mirza S, Thaper A, McClelland L, Jones S. Sinonasal cerebrospinal fluid leaks: management of 97 patients over 10 years. Laryngoscope. 2005; 115:1774-7.
Castelnuovo P, Mauri S, Locatelli D, et al. Endoscopic repair of Cerebrospinal Fluid Rhinorrhoea: Learning from our failures. Am J Rhinol 2001;15:333-42.
Lindstrom DR, Toohill RJ, Loehrl TA, Smith TL. Management of cerebrospinal fluid rhinorrhoea: the Medical College of Wisconsin experience. Laryngoscope 2004; 114:669-74.