Endoscopic Repair of CSF Fistulae: A Ten Year Experience

Abstract

Introduction: Cerebrospinal Fluid (CFF) fistulae are repaired endoscopically with varying degrees of success around the world. Large series are still uncommon, and the results varied primarily because of the different techniques by different surgeons and also because of a variation in the patient profile in each series, for example, many series deal primarily with traumatic CSF leaks where the defects are larger and outcomes poorer.

Aim: To analyse the surgical outcomes of Endoscopic CSF rhinorrhea closure.

Materials and methods: This is a series of 34 cases operated upon primarily by one surgeon in two different centres over a period of 10 years.

Results: Of the 34 cases, 76% of the patients were women. Among the patients only 20.6% patients had a history of trauma preceding the CSF leak. The most common site of leak was in the fovea ethmoidalis in 19 (55.8%) followed by 10 (29.4%) in the cribriform plate. An overlay technique of placing the multiple layers of fascia and mucosa was used in 26 (76.5%) patients and underlay technique in the remaining. Postoperative lumbar drain was used in all patients.

Conclusion: Based on the treatment outcome of the 34 patients, it can be concluded that the success rate of a single endoscopic procedure in our experience is 97% and 100% following the second. Endoscopic approach for closure of CSF leak is safe with minimal complications and little morbidity.

Keywords: Endoscopic sinus surgery; Fovea ethmoidalis; Lumbar drain.

[Table/Fig-1]:

Incidence in males and females.

[Table/Fig-2]:

Site of leak.

[Table/Fig-3]:

Site of meningocele.