The efficacy of an endoscopic endonasal approach in the repair of cerebrospinal fluid fistula: a clinical analysis

Background: Cerebrospinal fluid (CSF) fistula is an abnormal CSF leakage due to bone and/or dural defect of the skull base and usually operated with endonasal endoscopic approach. The aim of this study was to determine the efficacy of an endonasal endoscopic approach in the repair of CSF leakage and to find the reasons of the recurrence of endoscopic procedure. Methods: The medical records of 24 patients that presented with the diagnosis of cerebrospinal fluid fistula and who had undergone endonasal endoscopic repair surgery were reviewed retrospectively. Results: 13 patients (54.2%) were found to have spontaneous CSF fistulas without any history of trauma, while 11 patients (45.8%) had posttraumatic CSF fistulas. The mean body mass index (BMI) of patients was 31. 3 kg/m² (20.1-49.6). Nasal septal cartilage was used as a graft material in 19 patients (79%) while only fascia was used in 5 patients (21%). The evaluation of long-term results revealed recurrence in 4 patients (16.6%). Two of these patients required a second surgical repair. Conclusions: An endoscopic endonasal approach is a safe method with less morbidity and a reliable outcome in the repair of CSF fistulas. The most important causative factors in the recurrence of endoscopic repair of CSF leak might be to have high BMI and not to use multilayered graft material for closure of fistula.