CSF Rhinorrhea: Pathophysiology, Diagnosis and Skull Base Reconstruction

Review by R Gohil
Edinburgh, UK

Most reference books in medicine tend to be all encompassing texts that cover the entire breadth of the subspecialty in question – and many examples of this come to mind. Therefore it was very refreshing to review the book: CSF Rhinorrhea. This text simply serves to give the reader a deep dive into this one very specific topic, covering it in a great many aspects.

Published by Springer and in its first edition, this book has four named senior editors who are all renowned surgeons in the field of skull base surgery (AlQahtani, Castelnuovo, Casiano and Carrau). The global influence of these editors has drawn a far reaching group of contributors from all over the world. As the book’s spelling may suggest, there is some North American influence to this work. Given the wide-ranging contribution, the overall quality of the content is commendable.

This hardbound book is just over 400 pages and divided into six distinct parts comprising a total of 40 chapters. The parts cover basic science; clinical presentation and diagnosis; aetiology; surgical management; complementary topics in surgical management and patient management.

It goes without saying that the chapters on surgical management of CSF rhinorrhoea form the largest part with each chapter addressing a different kind of flap or graft; alongside specific considerations on the anatomical site of the leak. These chapters read as an instructional guide on how to perform these operative manoeuvres – which will be of great benefit to the new or established skull base surgeon. Each chapter is loaded with high quality clinical images and diagrams to add further clarity to what is complex surgery. High resolution videos are also available online through online registration.

Particular chapters of note include the Multidisciplinary Approach to CSF Leak, which very elegantly takes the reader through the author’s institutional experience of working with other specialties, and their value added, to optimally manage patients of varying complexity. The MDT approach proves to be the very backbone of complex patient management in most instances.

The chapter on Patient Advocacy and Medicolegal Issues in CSF Rhinorrhea is the very last chapter in the book but one I found to be the most thought provoking. It covers topics of informed consent and documentation; the value of tools such as image guidance and how to approach a post-operative patient who has suffered an iatrogenic leak. Although specific to CSF leaks, the take home points are applicable across the board.

I would say that this book is focused on delivering a succinct single point of reference to the endoscopic skull base surgeon or fellow, rather than an essential text for the trainee sitting their exam. CSF Rhinorrhea should however have pride of place in the departmental surgical library due to its value as a high-quality reference.

Amazon Link: CSF Rhinorrhea: Pathophysiology, Diagnosis and Skull Base Reconstruction
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