Endoscopic transnasal intradural repair of anterior skull base cerebrospinal fluid fistulae.

摘要

This study presents the techniques and results of endoscopic diagnosis and repair of cerebrospinal fluid (CSF) fistulae involving the anterior skull base and paranasal sinuses. Design. A retrospective cohort study of all consecutive patients undergoing endoscopic repair of anterior skull base CSF fistulae. Setting. Tertiary referral institutions. Materials and methods. Fifty-two patients underwent endoscopic repair of CSF fistula. Thirteen cases were traumatic in origin, 11 spontaneous not associated with meningoencephalocele and 12 with meningoencephalocele. Eleven were iatrogenic and five associated with transphenoidal pituitary surgery, two acute and three delayed following radiotherapy. The average age of patients was 43 and the male to female ratio was 2:1. A variety of techniques were used to repair the dural defect. In the majority of cases placement of a fat plug on the intracranial surface of the dura was performed. Results. Forty-seven of the 52 patients had successful primary endoscopic repair of the CSF fistula and skull base defect. Five patients required a repeat procedure due to early failure of the repair. After an average follow-up of 27 months no patient has had any recurrence of leak giving a primary closure success rate of 90% and secondary closure rate of 100%. Conclusions. The endoscopic transnasal approach for repair of anterior skull base CSF fistula is a reliable technique and is now the procedure of choice for patients presenting with this problem.