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Extracranial Repair of Pediatric Traumatic Cerebrospinal Fluid Rhinorrhea
Matthew Ng, MD;
Dennis R. Maceri, MD;
Michael M. Levy, MD;
Dennis M. Crockett, MD
Arch Otolaryngol Head Neck Surg. 1998;124:1125-1130.
Objective To examine the methods of extracranial repair of traumatic defects in the cribriform plate and ethmoid roof resulting in persistent cerebrospinal fluid (CSF) rhinorrhea in pediatric patients.
Design Retrospective case series.
Setting A single-institution, tertiary care, pediatric hospital.
Patients Four children, ranging in age from 3 to 9 years, who sustained fractures in the cribriform plate or ethmoid roof.
Intervention Transnasal endoscopic repair in 4 patients, with 2 patients also undergoing external ethmoidectomy because of the large bony defect and the need for further exposure for repair.
Main Outcome Measures Time free from CSF leaks or recurrence, meningitis, and other postoperative complications.
Results All patients except 1 have been free of recurrent CSF leaks, meningitis, and other postoperative complications. The 3 patients who solely underwent the extracranial approach did not experience the complications of the traditional intracranial approach.
Conclusions In a select group of pediatric patients, the extracranial approach for the repair of CSF leaks is appropriate. Successful use of an extracranial approach in 3 of 4 patients supports this method.
From the Departments of Otolaryngology–Head and Neck Surgery (Drs Ng, Maceri, and Crockett) and Neurological Surgery (Dr Levy), Children's Hospital of Los Angeles and the University of Southern California School of Medicine. Dr Ng is now with the Department of Otolaryngology–Head and Neck Surgery, Johns Hopkins University, Baltimore, Md.
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