Factors Affecting Success Rates in Endoscopic Repair of CSF Rhinorrhea

Area of Science:

• Neurosurgery
• Otolaryngology
• Skull Base Surgery

Background:

• Cerebrospinal Fluid (CSF) fistulas, particularly those originating from the anterior skull base, pose a significant challenge in surgical repair.
• Endoscopic transnasal techniques have become a primary approach for addressing these complex defects.

Purpose of the Study:

• To evaluate the impact of various factors on the success rates of endoscopic transnasal CSF fistula repair.
• Key factors investigated include age, etiology, defect size, surgical technique (number of reconstruction layers), and the use of lumbar CSF drainage.

Main Methods:

• A retrospective review of 35 patients who underwent endoscopic transnasal repair for anterior skull base CSF fistulas between 2006 and 2020.
• Patients were analyzed based on reconstruction layering (2, 3, or 4 layers), defect size (<5mm, 5-10mm, >10mm), etiology, and lumbar drainage use (LD+ vs. LD-).

Main Results:

• A significantly higher recurrence rate was observed in patients with 2-layered reconstructions compared to those with 3 or 4 layers (p=0.049).
• The use of lumbar CSF drainage (LD+) was associated with a significantly lower recurrence rate (4.3%) compared to no drainage (LD-) (41.7%) (p=0.012).
• No significant differences in recurrence rates were found concerning age, defect size, defect location, or etiology.

Conclusions:

• For endoscopic transnasal repair of anterior skull base CSF fistulas, employing a reconstruction with at least three layers is crucial for improving success rates.
• The application of lumbar cerebrospinal fluid drainage is a key factor in reducing recurrence rates and enhancing overall repair success.