World Neurosurg. 2022 Feb 19:S1878-8750(22)00211-X. doi: 10.1016/j.wneu.2022.02.065. Online ahead of print.
ABSTRACT
OBJECTIVE: Conservative management of acute traumatic cerebrospinal fluid rhinorrhoea (TCR) results in cessation of the leak in most patients. The objective of this study was to estimate the incidence of recurrent cerebrospinal fluid (CSF) rhinorrhoea and meningitis in these patients on long-term follow-up and to determine the risk factors associated with them.
METHODS: Data on 50 patients with acute TCR who were successfully treated with conservative management between 2013 and 2015 and had long term follow-up was retrieved from our head injury database. Patient variables were analysed to determine the risk factors associated with recurrence of CSF rhinorrhoea and meningitis.
RESULTS: All patients in our series developed CSF rhinorrhoea within 48 hours of trauma. The mean duration of follow-up was 6.3 ± 1.3 years. CSF rhinorrhoea recurred in 16 (32%) patients, 15 (93.8%) of whom developed it within 3 years of trauma. Meningitis occurred in 5 (10%) patients and one of them died. Sphenoid sinus fractures and features of raised intracranial pressure on computerised tomography (CT) of the brain at admission were significantly associated with the development of meningitis. There were no risk factors identified for the recurrence of CSF rhinorrhoea.
CONCLUSIONS: Patients with acute TCR in whom rhinorrhoea subsides with conservative therapy, have the highest risk for recurrence of leak or meningitis within three years of the trauma. Therefore, we recommend that these patients be counselled about the need for periodic follow up for several years.
PMID:35192972 | DOI:10.1016/j.wneu.2022.02.065
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