Transnasal endoscopic treatment of cerebrospinal fluid leaks: 10 years' experience

The endoscopic repair of cerebrospinal fluid (CSF) leaks has become a routine procedure. This study describes the endoscopic closure of CSF leaks in a large series (36 patients) at the Jagiellonian University over 10 years (1999 to 2009). We describe the aetiology, defect location, graft material, presence of encephalocele, history of meningitis, intracranial pressure, recurrence, and follow-up. In our studies the aetiology of CSF leak was spontaneous in 4 cases, traumatic in 9, and iatrogenic in 23. The defect was most commonly located near the ethmoid and sphenoid bones. Our initial success rate after transnasal endoscopic treatment was 88.9% (32/36). However, the overall success rate of 97.2% (35/36) and the low morbidity in this series support the endoscopic approach as the standard of care for CSF leak closure. Follow-up ranged from 3 months to 5 years. Importantly, this high success rate can be achieved without the use of intrathecal fluorescein or a lumbar drain.