Objective : To determine the effi­cacy of subcranial trans-nasal repair of cerebrospinal fluid rhinorrhea with free autologous grafts by the com­bined overlay and underlay tech­niques using the surgical microscope and / or endoscope.
Patients and Methods: Twenty pa­tients with CSF rhinorrhea were in­cluded in this retrospective study. They were 13 males and 7 females. Their age ranged from 7 to 62 years (mean39.35). The etiologies of the leak were iatrogenic in 10 cases, spontaneous in 5 cases, traumatic in 4 cases and one case was associated with meningeo-encephalocele. Preop-
erative nasal endoscopic examina­tion, computed tomography (CT) with intrathecal non-ionic contrast and magnetic resonance image (MRI) were done when indicated. Endo­scopic and / or microscopic repair of CSF fistula was done by a combina­tion of both under lay and overlay re­pair with free autologous grafts as fol­lows: Gelfoam with fibrin glue, strips of fat, facia lata, Gelfoam with fibrin glue (underlay), septal cartilage, Gel-foam with fibrin glue and strips of fat (overlay).
Results : Complete closure of the leak was achieved in all patients. In one case of spontaneous CSF leak which was operated endoscopically,