Management of transnasal cerebrospinal fluid fistulas via endoscopic endonasal approach
DOI:
https://doi.org/10.59156/revista.v40i01.790Keywords:
CSF leak, Endoscopic endonasal approach, Nasoseptal flap, RhinorrheaAbstract
Background: cerebrospinal fluid (CSF) fistulas are classified according to their etiology: traumatic, iatrogenic, or spontaneous. Their resolution presents a surgical challenge in terms of defect location and the different reconstruction techniques. The endoscopic endonasal technique offers a minimally invasive alternative, with lower morbidity and higher success rates than conventional surgery.
Objectives: to describe our experience in the management of CSF fistulas via endoscopic endonasal approach, review the technique, and share technical details to optimize surgical outcomes.
Methods: a retrospective analysis was performed on a database of patients with cerebrospinal fluid (CSF) fistulas who underwent surgery between January 2012 and December 2024. Clinical and imaging characteristics, location, etiology, repair technique, use of continuous lumbar drainage, success rate, and complications were analyzed.
Results: a total of 24 patients were included; 41.6% of fistulas had spontaneous etiology, 29% traumatic, and 29% iatrogenic. The most frequent location was at the level of the olfactory sulcus. The sellar location was predominant in postoperative fistulas. The flap was the most frequently used graft for reconstruction, and continuous lumbar drainage was not routinely used. The overall success rate was 87.5%, with three cases requiring reoperation. The incidence of meningitis was 12.5%, limited to the postoperative group.
Conclusion: endoscopic endonasal repair of cerebrospinal fluid (CSF) fistulas is an effective and safe approach. Systematizing the technique and applying experience-based advice contributes to increasing the success rate and reducing complications.
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References
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