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Published on: February 29, 2020
Endoscopic repair of cerebrospinal fluid leak in paediatric patients
E Emanuelli1, P Bossolesi1, D Borsetto1
1ENT and Otosurgery Unit, Department of Neurosciences, University Hospital of Padua, Padua, Italy.
Insights
Endoscopic repair of cerebrospinal fluid (CSF) fistulas in children is safe and effective, offering a high success rate with minimal complications. This minimally invasive approach is suitable for various pediatric CSF leak cases.
Area of Science:
- Neurosurgery
- Pediatric Otolaryngology
- Skull Base Surgery
Background:
- Limited case series on endoscopic treatment of pediatric cerebrospinal fluid (CSF) fistulas exist.
- Endoscopic repair offers a lower complication rate compared to traditional craniotomy.
Purpose of the Study:
- To report institutional experience with pediatric CSF leaks.
- To demonstrate the safety and efficacy of the endoscopic approach for pediatric CSF fistulas.
Main Methods:
- Retrospective review of clinical records for pediatric patients undergoing endoscopic repair.
- Focus on anterior and middle fossa skull base defects.
Main Results:
- 10 pediatric patients (mean age 10 years) were included.
- Etiologies included congenital (2), trauma (6), and iatrogenic (2) causes.
- Successful repair in 9/10 patients with a single procedure; one recurrence required a second operation. Mean follow-up: 36 months.
Conclusions:
- Endonasal endoscopic technique is a safe and effective treatment for pediatric CSF fistulas.
- High success rates and low complication rates are achievable in pediatric patients of all ages.
Background:
In scientific literature exist fewer case series regarding endoscopic treatment of paediatric cerebrospinal fluid fistulas. Compared to craniotomy endoscopic repair does not reach wider consent even if craniotomy carries higher complications rate.
Objective:
The aim of the present study was to report our institutional experience on paediatric cerebrospinal fluid leak to demonstrate the safety and efficacy of the endoscopic approach in a variety of cases.
Methods:
Clinical records of all paediatric patients who underwent endoscopic repair of anterior and middle fossa skull base defects are reviewed for several parameters.
Results:
10 patients were enrolled, 6 males and 4 females with a mean age of 10 years. The aetiology of the leak was congenital in 2 cases, trauma-induced in 6 cases and iatrogenic in 2 cases. In all the cases the defect was localized by computed tomography. Remedial was obtained using multiple grafts technique with autologous materials during a single procedure in all but one case, this one case requiring a second operation for delayed recurrence. The mean follow-up duration is 36 months.
Conclusion:
CSF fistulas can be approached in paediatrics of any age with high success and low complications rate using the endonasal technique.
