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Open Access Highly Accessed Short Report

Surgical challenge: endoscopic repair of cerebrospinal fluid leak

Carlos Martín-Martín1, Gabriel Martínez-Capoccioni2*, Ramón Serramito-García3 and Federico Espinosa-Restrepo1

Author Affiliations

1 Servizo Galego de Saúde. Service of ENT–Head and Neck Surgery, University Hospital Complex of Santiago de Compostela (CHUS), Santiago de Compostela, Spain

2 Servizo Galego de Saúde. Service of ENT–Head and Neck Surgery, Hospital da Barbabanza, La Coruña, Spain

3 Servizo Galego de Saúde. Service of Neurosurgery, University Hospital Complex of Santiago de Compostela (CHUS), Santiago de Compostela, Spain

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BMC Research Notes 2012, 5:459  doi:10.1186/1756-0500-5-459

Published: 27 August 2012

Abstract

Background

Cerebrospinal fluid leaks (CSF) result from an abnormal communication between the subarachnoid space and the extracranial space. Approximately 90% of CSF leak at the anterior skull base manifests as rhinorrhea and can become life-threatening condition. Endoscopic sinus surgery (ESS) has become a common otolaryngologist procedure. The aim of this article is to consider our experience and to evaluate the outcomes in patients who underwent a purely endoscopic repair of CSF leaks of the anterior skull base.

Findings

Retrospective chart review was performed of all patients surgically treated for CSF leaks presenting to the Section of Nasal and Sinus Disorders at the Service of ENT–Head and Neck Surgery, University Hospital Complex of Santiago de Compostela (CHUS), between 2004 and 2010. A total of 30 patients who underwent repair CSF leak by ESS. The success rate was 93.4% at the first attempt; only two patients (6.6%) required a second surgical procedure, and none of it was necessary to use a craniotomy for closure. Follow-up periods ranged from 4 months to 6 years.

Conclusion

Identifying the size, site, and etiology of the CSF leak remains the most important factor in the surgical success. It is generally accepted that the ESS have made procedures minimally invasive, and CSF leak is now one of its well-established indications with low morbidity and high success rate, with one restriction for fistulas of the posterior wall of the frontal sinus should be repaired in conjunction with open techniques.

Keywords:
Cerebrospinal fluid leak; Endoscopic sinus surgery; Anterior skull base; Bone defect; Bacterial meningitis