A patient of head injury was brought to the hospital. Patient was conscious having clear nasal discharge through right nostril. NCCT head was done which revealed non-operable injury to frontobasal area. What is the most appropriate management?
Ans. a. Wait and watch for 4-5 days to allow spontaneous healing The most appropriate management of a conscious patient of head injury with clear nasal discharge through right nostril with non-operable injury to frontobasal area on NCCT head is wait and watch for 4-5 days to allow spontaneous healing. `Early cases of post-traumatic CSF rhinorrhea are managed conservatively by placing the patient in the semi-sitting position, avoiding blowing of nose, sneezing and straining. Prophylactic antibiotics are also administered to prevent meningitis. Persistent cases of CSF rhinorrhea are treated surgically by nasal endoscopic or intracranial approach. Nasal endoscopic approach is useful for leaks from the frontal sinus, cribriform plate, ethmoid or sphenoid sinuses.'] CSF Rhinorrhea The underlying defect responsible for CSF leaks, regardless of the etiology: disruption in the arachnoid and dura mater coupled with an osseous defect and a CSF pressure gradient that is continuously or intermittently greater than the tensile strength of the disrupted tissue. Etiology: Penetrating and closed-head trauma are responsible for 90% of all cases of CSF leaksQ Clinical features: CSF rhinorrhea following a traumatic injury is classified as immediate (within 48 hours) or delayedQ The majority of patients with a CSF leak due to accidental trauma (e.g., motor vehicle accident) present Most of the patients (95%) with a delayed CSF leak present within 3 months after the injuryQ The typical history of a CSF leak is that of clear, watery discharge, usually unilateralQ Diagnosis is made more easily in patients with recent trauma or surgery than in others Treatment Early cases of post-traumatic CSF rhinorrhoea are managed conservatively by placing the patient in the semi-sitting position, avoiding blowing of nose, sneezing and straininge. Prophylactic antibiotics are also administered to prevent meningitis. Persistent cases of CSF rhinorrhoea are treated surgically by nasal endoscopic or intracranial approache. Nasal endoscopic approach is useful for leaks from the frontal sinus, cribriform plate, ethmoid or sphenoid sinuses
Wait and watch for 4-5 days to allow spontaneous healing
Do an MRI to localize the leak and control the discharge endoscopically
Put a dural catheter to control CSF leak
Approach transcranially to repair the damaged frontobasal region