Sinonasal cerebrospinal fluid leaks: management of 97 patients over 10 years

Although endoscopic closure is now the treatment of choice in the majority of patients with sinonasal cerebrospinal fluid (CSF) leaks, there is a recurrence rate of up to 10% in most series.

Our aim was to review our experience in the management of CSF leaks and in particular the cause of recurrent leaks.

We prospectively collected data on all cases referred as a suspected CSF leak to us, a tertiary referral center, over a 10 year period between 1994 and 2004.

The 121 patients referred with an apparent CSF leak had a mean age of 51 (range 2-87) years. Fifty-three percent were male, and 47% were female. In 24 cases, investigations revealed that there was in fact no CSF leak, and in 17 posttraumatic cases, the leak ceased spontaneously. Twenty-nine patients had a spontaneous CSF leak. Of the 80 cases surgically repaired, 72 had an endoscopic approach, with a success rate of 90%, increasing to 97% after a second procedure and 99% by a third procedure. Eight patients with a posterior wall frontal sinus leak underwent an external frontal sinus procedure. There were 8 failures, and 6 occurred in the 13 patients with a spontaneous leak and evidence of raised intracranial pressure (ICP).

In conclusion, our endoscopic repair rate for sinonasal CSF leaks are good and compare well with the standards in the literature. Raised ICP is the most common reason for recurrent CSF leak after repair. Patients with a spontaneous CSF leak and evidence of raised ICP had a 46% failure rate. When consenting such patients for surgery, they must be informed of the lower success rate and that they may need additional procedures, including shunting.