A Systematic Review of the Endoscopic Repair of Cerebrospinal Fluid Leaks

Abstract

The endoscopic repair of CSF fistula is both safe and effective and should be considered the standard of care for most cases. Evidence supporting adjunctive measures such as lumbar drains and antibiotics remains limited despite their common use.

Endoscopic Management of Cerebrospinal Fluid Rhinorrhea: The Charing Cross Experience

“…The overall success rate of 93% at first surgery and 100% at second surgery compares well with the literature. [12][13][14][15] All operations were performed by the senior author (HAS).…”

“…7,[12][13][14][15][16][17] This may be explained by our unit being a tertiary referral center and having close links with a neurosurgical unit, possibly resulting in a skewed patient population. Additionally, several traumatic leaks were successfully managed with conservative measures under the care of the neurosurgeons and did not enter our database.…”

“…6 A recent systematic review indicates, however, that lateral recess of sphenoid and ethmoid roof defects are more frequent. 15 Idiopathic intracranial hypertension is not well understood, and management of these patients lacks a clear evidence base. 22 Whatever the cause, the higher pulsatile pressures lead to erosion of the skull base with a predilection for the thinnest areas, namely the cribriform plate and lateral sphenoid recess.…”

“…13 However, some publications cite sphenoid and ethmoid defects as more common. 12,15,24 We had two cases of iatrogenic CSF leaks secondary to endoscopic sinus surgery referred to our unit, whereas most cases were secondary to extensive base of skull or neurosurgery in contrast to the literature. 2 As a result, a larger proportion of sphenoid defects were noted in iatrogenic injuries, principally after trans-sphenoidal pituitary surgery.…”

“…We also used a low concentration of intrathecal fluorescein, and such low concentrations have been shown to have good safety and efficacy. 15 We incorporated the use of a variety of grafts, and success rates of differing grafts have been shown to be similar. 29 In large skull base defects, the use of vascularized tissue grafts has been correlated with lower failure rates.…”