[Endonasal treatment of iatrogenic or spontaneous cerebrospinal rhinorrhea of the anterior cranial fossa].

There is a 25% risk of meningitis in case of cerebrospinal fluid rhinorrhea from the anterior cranial fossa. Treatment usually is based on neurosurgery when medical management is unsuccessful. The risk of morbidity and mortality in such operations is important and recurrence is observed in 25% of the cases. The development of endonasal surgery has increased the incidence of iatrogenic breaches but has also allowed the development of new techniques for closing breaches. Certain authors recently published a recent series of patients treated via the endonasal route. We present here six cases of cerebrospinal fluid rhinorrhoea from the anterior cranial fossa treated at the Foch Hospital. Etiology was iatrogenic in 4 cases, trauma in 1 and spontaneous in 1. The operative technique and mid-term results are presented. Cure was achieved in all cases after a mean follow-up of 2 years. One patient with osteopetrosis of the cranial floor who underwent neurosurgical decompression of the optic nerve complained of recurrent rhinorrhoea which could not be confirmed by endoscopy nor by imaging. Early endoscopic treatment of cerebrospinal fluid rhinorrhoea should be the first intention option as it preserves olfactive function, limits operative morbidity and mortality and leaves open the option of neurosurgery in case of failure.