{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,10]],"date-time":"2026-03-10T03:47:40Z","timestamp":1773114460275,"version":"3.50.1"},"reference-count":49,"publisher":"MDPI AG","issue":"21","license":[{"start":{"date-parts":[[2022,10,25]],"date-time":"2022-10-25T00:00:00Z","timestamp":1666656000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["IJERPH"],"abstract":"<jats:p>Background: Cerebrospinal fluid (CSF) rhinorrhea requires proper management to avoid disastrous consequences. The objectives of this study were to ascertain the patient characteristics, etiologies, sites of defect, skull base configurations, methods of investigation, and management outcomes of CSF rhinorrhea. Methods: A retrospective study was performed over 4 years involving three surgeons from Malaysia, Singapore, and Thailand. Hospital records were reviewed to determine the patients\u2019 characteristics, the causes and sites of leaks, methods of investigation, skull base configurations, choices of treatment, and outcomes. Results: A total of 15 cases (7 traumatic and 8 non-traumatic) were included. Imaging was performed in all cases. The most common site of leakage was the cribriform plate (9\/15 cases). The mean \u00b1 SD of the Keros heights were 4.43 \u00b1 1.66 (right) and 4.21 \u00b1 1.76 mm (left). Type II Keros was the most common (60%). The mean \u00b1 SD angles of the cribriform plate slope were 51.91 \u00b1 13.43 degrees (right) and 63.54 \u00b1 12.64 degrees (left). A class II Gera configuration was the most common (80%). All except two patients were treated with endonasal endoscopic surgical repair, with a success rate of 92.3%. A multilayered repair technique was used in all patients except one. The mean \u00b1 SD postoperative hospital stay was 9.07 \u00b1 6.17 days. Conclusions: Non-traumatic CSF rhinorrhea outnumbered traumatic CSF rhinorrhea, with the most common site of leak at the cribriform plate. Imaging plays an important role in investigation, and Gera classification appears to be better than Keros classification for evaluating risk. Both conservative and surgical repairs are practiced with successful outcomes. Endonasal endoscopic CSF leak repair is the mainstay treatment.<\/jats:p>","DOI":"10.3390\/ijerph192113847","type":"journal-article","created":{"date-parts":[[2022,10,25]],"date-time":"2022-10-25T21:58:06Z","timestamp":1666735086000},"page":"13847","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":8,"title":["Management of Traumatic and Non-Traumatic Cerebrospinal Fluid Rhinorrhea\u2014Experience from Three Southeast Asian Countries"],"prefix":"10.3390","volume":"19","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-8725-0111","authenticated-orcid":false,"given":"Farah Dayana","family":"Zahedi","sequence":"first","affiliation":[{"name":"Department of Otorhinolaryngology-Head & Neck Surgery, Faculty of Medicine, Universiti Kebangsaan Malaysia, Kuala Lumpur 56000, Malaysia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Somasundaram","family":"Subramaniam","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology\u2013Head and Neck Surgery, National University of Singapore, Singapore 119077, Singapore"},{"name":"Department of Otolaryngology\u2013Head and Neck Surgery, Ng Teng Fong General Hospital, Singapore 609606, Singapore"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Pornthep","family":"Kasemsiri","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology\u2013Head and Neck Surgery, Srinagarind Hospital, Faculty of Medicine, Khon Kaen University, Khon Kaen 40000, Thailand"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Chenthilnathan","family":"Periasamy","sequence":"additional","affiliation":[{"name":"Department of Otorhinolaryngology\u2013Head and Neck Surgery, Penang General Hospital, George Town 10990, Malaysia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9138-9215","authenticated-orcid":false,"given":"Baharudin","family":"Abdullah","sequence":"additional","affiliation":[{"name":"Department of Otorhinolaryngology\u2013Head and Neck Surgery, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian 16150, Malaysia"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2022,10,25]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"214","DOI":"10.1136\/jnnp.31.3.214","article-title":"Non-traumatic cerebrospinal fluid rhinorrhoea","volume":"31","author":"Ommaya","year":"1968","journal-title":"J. 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