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Review
. 2025 Jul 12.
doi: 10.1002/lary.32428. Online ahead of print.

Outcomes of Endoscopic Management of Spontaneous Cerebrospinal Fluid Rhinorrhea: A Meta-Analysis

Zahir Mughal  1 , Judith Osuji  1 , Syntyche Jonah  1 , Kishan Rajdev  1 , Priyamal Silva  1 , Rajeev Mathew  1 , Samuel Mackeith  1 , Alexandros Boukas  2 , Sanjeeva Jeyaretna  2   3 , Pablo Martinez-Devesa  1 , Ali Qureishi  1
Affiliations
Review

Outcomes of Endoscopic Management of Spontaneous Cerebrospinal Fluid Rhinorrhea: A Meta-Analysis

Zahir Mughal et al. Laryngoscope. .

Abstract

Objective: Although endoscopic surgery has advanced the treatment of cerebrospinal fluid (CSF) rhinorrhea, spontaneous leaks remain challenging due to their higher recurrence rates compared to other etiologies. This systematic review aims to identify factors influencing surgical success.

Data sources: Medline, Embase, Cochrane, and Web of Science were searched on 26 October 2024, and updated on 9 June 2025.

Review method: A meta-analysis was conducted to estimate the pooled success rates, and meta-regression was used to explore the impact of demographic and surgical factors. Study quality was appraised using the JBI critical appraisal tool.

Results: A total of 47 studies, encompassing 2586 patients, met the inclusion criteria. The pooled primary repair success rate was 93.7% (95% CI 91.5%-95.7%), and the overall success rate after revision surgery was 99.7% (95% CI 98.9%-100%). Multilayer reconstruction demonstrated higher success rates (94.6%, 95% CI 91.6%-97.1%) compared to single-layer techniques (87.6%, 95% CI: 77.7%-95.1%), although the difference was not statistically significant (p = 0.09). Perioperative lumbar drain use did not significantly affect outcomes (p = 0.4). Skull base defects involving the sphenoid sinus were associated with lower success rates (p = 0.0004). The overall quality of evidence was moderate.

Conclusions: Endoscopic repair remains the gold standard for managing spontaneous CSF rhinorrhea. Reconstruction technique and lumbar drain use did not significantly influence surgical success. Randomized controlled trials are warranted to validate these findings.

Level of evidence: N/A.

Keywords: anterior skull base; cerebrospinal fluid leak; complications; endoscopic repair; meta‐analysis; recurrence; success rate.

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References

    1. Z. Mughal, P. Martinez‐Devesa, A. Boukas, S. Jeyaretna, and A. Qureishi, “Contemporary Management of Cerebrospinal Fluid Rhinorrhoea: A Review of the Literature,” Journal of Clinical Medicine 14, no. 3 (2025): 995.
    1. Y. Khafagy, A. Arman, and A. Khafagy, Cerebrospinal Fluid (CSF) Rhinorrhea. (Current Rhinology) (Springer Nature, 2024), 597–624.
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    1. R. J. Schlosser, B. A. Woodworth, E. M. Wilensky, M. S. Grady, and W. E. Bolger, “Spontaneous Cerebrospinal Fluid Leaks: A Variant of Benign Intracranial Hypertension,” Annals of Otology, Rhinology, and Laryngology 115, no. 7 (2006): 495–500.
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