Introduction: Spontaneous nasal liquorrhea (SNL) – is a multifactor pathology that requires modern approaches for its diagnosis and surgical treatment.
Methods: We analyze and evaluate the results of lumboperitoneal shunt (LPSH) in patients with SNL according to 20-year catamnesis.
The study included 38 patients (33 female) aged 15-60 years (mean age 45,1 years) with SNL treated at the Institute of Neurosurgery. In 26 (68,4%) cases patients were operated before 2000, when endoscopic endonasal surgery for CSF leakage in Russia was not actively used in everyday practice.
Evaluation of surgical results was based on the history of anamnesis (disease), examinations in dynamics and patient questionnaires. The operation was considered effective if there were no nasal CSF leak and meningitis and no deterioration in neurological symptoms in a postoperative period.
Results: Recurrence of spontaneous CSF leakage (liquorrhea) in primary LPSH reached 20 (52,6%). Recurrence was most frequent within 2-6 months and 1-4 years after surgery.
Patients with recurrent SNL after primary endoscopic endonasal surgery and / or lumboperitoneal shunt underwent 11 LPSH or shunt revision; recurrence of CSF leakage was observed in 8 (72,7%) cases.
Four (8,2%) patients in catamnesis developed meningitis: in 1 of them meningoencephalitis occurred in 3 years after surgery (LPSH) and turned to be fatal.
Shunting procedure also has its shortcomings: preservation of the CSF fistula; redistribution of liquor balance (disturbed liquorodynamics) in long-functioning shunts; shunt malfunction with time caused by blockage or coalescence due to protein deposits, cells.
Conclusions: LPSH is recommended for recurrent and / or progressive spontaneous liquorrhea without clearly verifiied CSF fistula, inefficiency and direct endoscopic endonasal surgery (transcranial) interventions.
Patient Care: It provide the new information for treatment selection plan based on the long-term study results
Learning Objectives: By the conclusion of this session, participants should be able to evaluate the role of the lumboperitoneal shunt in treatment of patients with spontaneous CSF leak