Commentary

The authors report nine patients who underwent endoscopic repair of a cerebrospinal fluid (CSF) leak. They achieved excellent results using a much less invasive approach than a traditional bifrontal craniotomy. We prefer to use septal or conchal cartilage to fill the defect. We also use temporalis fascia. We have not used fluorescein dye and have been able to visualize CSF leakage without difficulty. Furthermore, the use of flourescein intrathecally has been associated with seizures. We also supplement the repair with Gelfoam and fibrin glue to seal the defect. Finally, we use frameless image guidance during surgery to avoid perforation through the anterior cranial fossa and to achieve the most direct approach. Clearly, this approach has become a very attractive, less invasive option for the treatment of CSF leaks. In most cases, it should be attempted before a craniotomy.