Abstract: Objective To explore the treatment method of cerebrospinal fluid nasal leakage. Methods: Twelve cases of cerebrospinal fluid leakage were repaired by using E C medical otolaryngology under nasal endoscopy. The results: 12 cases of cerebrospinal fluid leakage were successfully repaired in one operation, and the patients were followed up for 6-18 months after the operation, and there was no case of recurrence of cerebrospinal fluid leakage and intracranial infection and other complications. Conclusion: The use of ECHE medical otorhinolaryngology to repair cerebrospinal fluid rhinorrhea under nasal endoscopy has the advantages of no facial scarring, minimally invasive, small impact on nasal function, and fewer complications, and improves the success rate of one-time surgical repair. Yu Guojie, Department of Otorhinolaryngology and Head and Neck Surgery, Affiliated Hospital of Guizhou Medical University, Guizhou, China Since P A P A Y (1989) reported the application of nasal endoscopy to repair cerebrospinal fluid rhinorrhea, this technique has been widely carried out, and the technique has basically matured, and transnasal endoscopic cerebrospinal fluid rhinorrhea repair has become the first choice for repairing cerebrospinal fluid rhinorrhea. In addition to the direct use of the middle turbinate and inferior turbinate tissues and mucosa in the nasal cavity and the extra-nasal muscles and fascia such as the temporalis muscle, temporalis fascia, and the broad fascia, the application of the medical ECD ear-brain adhesive has also been quite common.ECD ear-brain adhesive is a new type of special bioadhesive that has been developed in recent years, which is strong in adhesive strength and free of toxicity, and it has been used in a wide range of ear and brain surgeries. The clinical application of ECHG, either alone or mixed with temporal fascia, as a cerebrospinal fluid rhinorrhea repair material has greatly improved the success rate of surgical repairs. The authors have successfully repaired 12 cases of cerebrospinal fluid rhinorrhea under nasal endoscopy by using ECH gel from October 2001 to October 2005, and all of them achieved satisfactory results. Now we report as follows:1 Information and methods1 . 1 Clinical data The group of 12 patients. Male 7 cases, female 5 cases; age 18 -67 years old, average 39 years old. Cerebrospinal fluid leakage in the sieve sinus was 4 cases, 2 cases occurred in the sieve apex, 1 case in the anterior middle of the sieve plate, 1 case in the upper wall of the sieve sinus; cerebrospinal fluid leakage in the pterygoid sinus was 3 cases, 2 cases were in the pterygoid sinus mouth, 1 case was in the pterygoid sieve apex; cerebrospinal fluid leakage in the frontal sinus was 5 cases, 3 cases were in the posterior wall of the frontal sinus, 2 cases were in the upper wall of the frontal sinus. 5 cases were caused by craniocerebral trauma, 1 case was triggered by the resection of a tumor of the pituitary gland, 2 cases were caused by pterygoid sinus surgery, and 4 cases were spontaneous. All patients were examined by CT examination of the base of the sinus, and the smallest leakage in the patients was only a small fissure, and the largest one was 1.5*1.2cm. Two cases were associated with deviated nasal septum, and two cases were associated with chronic sinusitis. All patients had different degrees of running clear mucus, which was aggravated when they lowered their head, and all of them collected the leaking fluid for quantitative glucose determination, with the level of glucose in the range of 3.17-4.52 mol/L, and all of them were positive in qualitative tests.1 . 1.2 Surgical methods Cerebrospinal fluid leakage surgery of frontal sinus was performed in the lying position, and cerebrospinal fluid leakage surgery of sieve sinus and pterygoid sinus was performed in the backward position with shoulder pads.12 patients were put under general anesthesia, and were intubated through the orotracheal tube, and the nasal cavity was constricted with epinephrine-containing 1 % bupivacaine cotton wool pads. Thigh muscles, broad fascia or glabellar muscles, and fascia were taken, and the muscles were crushed to make muscle paste, and the fascia was spread on a curved disk and left to dry for use. Under the direct vision of nasal endoscope at 70°, the middle turbinate was fractured outwardly and the nasal septum was pushed to the opposite side, fully exposing the sieve apex and the pterosaxial fossa, part of the middle turbinate was resected if necessary, and the bipolar electrocoagulation was performed to stop the hemorrhage, and the adhesion bands were resected if adhesions were caused in the nasal cavity after traumatic injury, and the subseptal herniorrhaphy had been done in two cases of severe deviated septum, and the whole group of sinusitis had been opened in one case. According to the order of the anterior part of the roof of the nose, the posterior part, the middle nasal tract, the pterygoid sieve fossa, careful observation, if necessary, compression of the internal jugular vein to promote the outflow of cerebrospinal fluid, in order to track to find the site of repeated holes. For sieve sinus cerebrospinal fluid leakage, firstly, the airspace around the leak was occluded to the level of sieve bone, and part of the dura mater was exposed. A small otological spatula was used to gently scrape the 1.5-2.0mm area of Hepatic membrane around the leakage to make a fresh wound, which was easy to be glued with ear glue. At the same time, intravenous rapid drip 2 0% mannitol to reduce the cranial pressure to reduce the cerebrospinal overflow, E C ear brain glue drops in the leak around the mouth, to pound the muscle to fill the leak, external pressure on the fascia, in the surface of the fascia again injected with E c ear brain glue, so that it is completely bonded with the surrounding tissues to fix, and external pressure on the gelatine sponge, and will be tightened, fixed to the hardening of the nose, nasal filling iodine imitation gauze, the postoperative semi-sitting position, a low-salt diet, dehydration to reduce cranial pressure and antibiotic treatment, 5 a 10 0%, and then the nasal cavity, the nasal cavity, the nasal cavity, the half-sitting position, low-salt diet, dehydration to lower cranial pressure and Postoperatively, the patient was placed in semi-sitting position, with low-salt diet, dehydration to reduce cranial pressure and antibiotic treatment, and the nasal stuffing gauze was extracted after 5-10d. Pterygoid sinus cerebrospinal fluid rhinorrhea used septal pterygoid approach pterygoid sinus exploration, open the anterior wall of the pterygoid sinus, bite off the sinus septum, excise the mucous membrane in the sinus cavity, electrocoagulation hemostasis, 30 °, 70 ° endonasal endoscopy under the direct visualization of the pterygoid sinus leakage site. Bone defects can be used septum sieve bone vertical plate embedded in the saddle bottom or pterygoid sinus lateral wall defects, the E C otolaryngology drops around the leak bone defects, with crushed muscle filling, external pressure on the fascia, in the fascial surface of the E C otolaryngology drops again, with gelatin sponge compression, adipose tissue filled with the pterygoid sinus cavity fixation, septal mucous membrane reset, suture the incision of the nasal columella, bilateral nasal cavity filled with povidone-iodoform gauze, postoperative 5 a 10d remove the nose. Nasal stuffing was taken out 5-10d after operation. In patients with frontal sinus cerebrospinal fluid rhinorrhea with open frontal sinus injury, after removing the crushed bone of the anterior wall, frontal sinus leakage was explored under nasal endoscopy at 70°, and a small spatula was used to scrape off the surrounding Roux membranes in the bone around the cerebrospinal fluid leakage at a distance of about 2 cm, and then injected EC otolaryngology on the surface, and then the glabrous fascia was pressed on the surface of the fissure, and then injected again with EC otolaryngology and then compressed with gelatin sponge outside the fissure, and then sewed up the skin wounds.1 . 1.3 Postoperative treatment After cerebrospinal fluid rhinorrhea repair, patients should take a semi-sitting position, eat a low-salt diet, avoid lowering the head and touching the nose with force, limit the amount of drinking water, and treat with antibiotics. If the pressure of cerebrospinal fluid is high after surgery, 20% mannitol can be put on static drip to lower the cranial pressure, or cerebrospinal fluid can be drained by lumbar puncture to lower the cranial pressure, so as to promote the healing of leakage. 5-10d according to the patient’s condition to take out the stuffing in the nasal cavity.2 Results 12 patients were successfully repaired in one operation, and were discharged from the hospital after healing, and the patients were followed up 6-18 months after the operation, and no case of cerebrospinal fluid rhinorrhoea recurred, and no intracranial infections and other complications occurred.3 Discussion Cerebrospinal fluid leakage is most common in patients with traumatic, especially traumatic skull base fracture, sinus or skull base surgery can also lead to cerebrospinal fluid leakage, and the spontaneous ones are not rare. Conventional cerebrospinal fluid rhinorrhea repair has intracranial method and extracranial method, and the extracranial method is divided into intranasal method and extranasal method. The intracranial approach is indicated for those with other intracranial pathologies, and the success rate of surgical repair is less than 6%. With the development of nasal endoscopic surgery, endoscopic management has been extended from common inflammatory sinus disease to the sinus skull base region and to nasal and ophthalmic related areas. The main indications for reliable and safe nasal endoscopic skull base surgery are repair of cerebrospinal fluid leaks, pterygoid sinus cysts invading the base of the skull, pituitary tumors growing mainly under the saddle, and optic nerve canal fractures. Nasal endoscopic surgery to repair cerebrospinal fluid leakage has been widely carried out both at home and abroad, among which cerebrospinal fluid leakage of the sieve apex, the sieve plate and the pterygoid sinus is the best surgical indications for the operation of cerebrospinal fluid leakage.E C Ear Brain Gum is a synthetic high-functional adhesive, which can be directly applied to different tissues, and it can be cured to form a film in about 10S, and it has both good haemostatic and adhesive functions. The use of EC glue in nasal endoscopy can repair frontal, septal and parietal sinus cerebrospinal fluid rhinorrhea, the anvil membrane and dura mater around the leak should be scraped, so as to make it a fresh wound, in order to facilitate the adhesion of the medical EC ear-brain adhesive and to make the placement of the grafts and leaks tightly adhered to the ear-brain adhesive to play the role of adhesive reinforcement. If more than two materials are used, an adhesive is applied between the layers of the repair (ear and brain adhesive). The advantages are: it can reduce the pain of craniotomy and many intracranial complications; the application of ECC can greatly improve the success rate of the surgery; nasal endoscopic surgery can clarify the site and size of the leak, which not only helps in the diagnosis and treatment, but also serves as a good means of postoperative observation and improves the quality of the surgery; the nasal leakage fillings are made of extra-nasal tissues (muscle and fascia), which avoids the risk of using the nasal septum, turbinate or mucous membrane as the filler for the leakage. The nasal septum and mucous membrane of the nasal turbinate were filled with extra-nasal tissues (muscle and fascia) to avoid the bleeding of the nasal cavity caused by the use of nasal septum and mucous membrane of the nasal turbinate to fill up the nasal cavity, and the splashing of the mirror, which affects the surgical operation; it is important to clarify the site of leakage, and the clear fluid can be seen to be flowing during the operation, and a suction device can be used to trace the leakage of the cerebrospinal fluid until it is seen; local anesthesia was used in all the cases due to the patient’s pain and nervousness which affects the surgical operation. In the case of sinusitis or septal deviation, endoscopic septal correction and sinus open surgery can be performed at the same time. Nasal endoscopic repair of cerebrospinal fluid leakage also has the limitations of limited exposure of the frontal sinus; one-handed operation, which requires high technical requirements for nasal endoscopic surgery; the operation often involves important intracranial structures, especially the internal carotid artery and cavernous sinus, which makes the treatment of the injury quite difficult and urgent, and the patient may suffer from serious complications and the danger of death, etc., but these cases are not common. The key to transnasal endoscopic cerebrospinal fluid rhinorrhea repair is to accurately find the site of the leak. In conclusion, transnasal endoscopic repair of cerebrospinal fluid rhinorrhea is now the method of choice for repairing cerebrospinal fluid rhinorrhea, especially because the use of adhesives, such as otolaryngocele, plays a very important role in the adhesion and reinforcement of localized graft fillings, which greatly improves the success rate of the one-time surgical repair.H E C A Z Y et al. traced the success rate of transnasal endoscopic repair of cerebrospinal fluid rhinorrhea, with the success rate at the first attempt being 9%, and the success rate at the first attempt 52%, with the authors using a method of transnasal endoscopy. The authors used E C Ear Cerebrospinal Gel to repair 12 cases, all of which were successfully repaired at one time. Further clinical studies are needed to determine the size of the leak that caused the leak and the basis for the correct choice of repair material.