Surgical Treatment of CSF Leak via Endoscopic Endonasal Approaches: Case Series

Background: A nasal CSF leak despite its etiology still remains a significant issue and could cause serious complications. Surgery is a treatment of choice where an endoscopic technique utilized via endonasal approaches is most effective option.

Objective: The aim of this study is to present results of nasal CSF leak treatment via endoscopic endonasal approaches.

Methods: A single-center retrospective chart review of all patients with nasal CSF-leak was performed. A period of surgery was between 2010 and 2018. All surgeries were purely endoscopic. Demographic data, site and Grade of CSF leak, reconstruction technique, complications and outcomes were collected.

Results: A total 52 patients with CSF leak were identified. There were 31 females and 21 males. Patient’s age was between 17 and 77 years (median 51 ± 1.75). The site of CSF leak localized at ethmoidal cells—32 (61.53%) cases, cribriform plate—6 (11.53%) cases, clivus—4 (7.69%) cases, planum sphenoidale—4 (7.69%) cases, sphenoid sinus—3 (5.76%) cases, sella turcica—3 (5.76%) cases. According to the cause of CSF leak, there were 29 (55.76%) cases associated with meningocele, 9 (17.3%) posttraumatic, 7 (13.46%) after transcranial surgery, 5 (9.61%) were spontaneous, and 2 (3.84%) were associated with skull base tumors. There were 24 (46.15%) cases of Grade I, 24 (46.15%) cases of Grade II, and 4 (7.69%) cases of Grade III. In the vast majority of cases, 27 (51.92%), a vascularized nasoseptal flap was used for reconstruction. Other type of reconstruction includes the use of free mucosal flap of the middle turbinate—12 (23.07%) cases, fascia lata—11 (21.15%) cases, and vascularized pericranial flap in 2 (3.84%) cases. Five patients developed a postoperative CSF leak. Four patients were reoperated and three of them required a subsequent shunting due to associated hydrocephalus. In one case, a CSF leak resolved on lumber drainage. In one patient during revision surgery 1 year after initial surgical treatment, a right ICA was damaged. It was a dehiscence. Full bleeding control by bipolar coagulation was achieved without any further complications. No other complications were detected. A postoperative CSF leak in the series was 9.61%.

Conclusion: Endoscopic endonasal approaches are safe and effective for the nasal CSF-leak treatment of different origin and cause. Preoperative planing based on anatomical and MRI/CT features is crucial.

No conflict of interest has been declared by the author(s).