Endoscopic endonasal approaches for cerebrospinal fluid leaks repair

A variety of techniques have been described for the repair of cerebrospinal fluid (CSF) leaks at the anterior skull base. Conservative management includes bed rest, avoidance of straining activities, and temporary CSF diversion with serial lumbar punctures or lumbar drains. Surgical repair may be achieved transcranially through a bifrontal craniotomy, extracranially through an external ethmoidectomy or frontal sinusotomy, or transnasally with microscopic or endoscopic visualization.

Between January 2006 and May 2011, 30 patients with nontraumatic and traumatic CSF rhinorrhea were treated at the Departments of Neurosurgery and Maxillofacial Surgery of the Universities of Rome 'La Sapienza'. All patients underwent surgery: 5 patients (15%) were treated by a combined intracranial and endoscopic endonasal approach and 25 patients were treated (91.1%) by the endoscopic endonasal approach alone. In our study, we used autologous material, the fascia lata, free grafts of septal or middle turbinate mucoperichondrium, and septal cartilage grafts, and in cases with a large deficit in the posterior wall of the sphenoid or clivus, a pedicle flap from sphenopalatine artery of septal mucosa is used.

Only in 2 cases was there an appearance of secondary rhinoliquorrhea with a success rate of 94%, in line with what is described in international literature.

Posttraumatic cerebrospinal leak in our experience can be treated through endoscopic approach, in selected cases, using autologous materials with a few relapse of the pathology. Endoscopic endonasal technique offers a high viewing of surgical field and it permits to manage even larger lesions with minimally invasivity.