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Review
. 2020 Feb;42(2):344-356.
doi: 10.1002/hed.25981. Epub 2019 Nov 4.

The surgical treatment of cerebrospinal fistula: Qualitative and quantitative analysis of indications and results

Alessandra Iavarone  1 , Paolo Luparello  1 , Maria Silvia Lazio  1 , Lara Valentina Comini  1 , Federica Martelli  1 , Oliviero De Luca  2 , Giovanni Paolo Santoro  2 , Roberto Santoro  2 , Giammarco Alderotti  3 , Giuditta Mannelli  2
Affiliations
Review

The surgical treatment of cerebrospinal fistula: Qualitative and quantitative analysis of indications and results

Alessandra Iavarone et al. Head Neck. 2020 Feb.

Abstract

Cerebrospinal fistula might occur in different ways. CSF closure techniques have undergone significant evolution that has led to the consolidation of the transnasal endoscopic approach. Despite the existence of multiple publications, meaningful information is still lacking in clinical practice and the literature about the ideal method, material, and timing for repair of CSF. The purpose of this review was to summarize the success rate of endoscopic CSF leak repair as well as whether specific techniques or materials influence the primary success rate through a review of the latest advancements in endoscopic CSF management published in the past 10 years. The principles of multilayer reconstructions and the routine use of vascularized flaps in expanded endonasal surgery have reduced postoperative CSF leaks' failure rates between 5% and 10% (4% in this meta-analysis). Effective endoscopic anterior skull base (ASB) closure may be achieved by multiple reconstructive techniques, which should be tailored case by case according to the patient and defect conditions.

Keywords: cerebrospinal fistula; endoscopic treatment; meta-analysis; systematic review; transnasal endoscopic surgery.

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References

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