Endoscopic endonasal repair of anterior skull base non-traumatic cerebrospinal fluid leaks, meningoceles, and encephaloceles

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  • 1 Departments of Otorhinolaryngology and
  • 2 Neurological Surgery, Weill Cornell Medical College, New York Presbyterian Hospital, New York, New York
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Object

The endoscopic endonasal approach has become the preferred technique for CSF leak and encephalocele repair of the anterior skull base. The purpose of this study is to identify patient characteristics; review adjunctive perioperative treatments, reconstruction techniques, and outcomes; and identify risk factors for failure in patients undergoing endoscopic endonasal repair of anterior skull base CSF leaks and encephaloceles.

Methods

This is a prospective observational study of patients undergoing endoscopic endonasal repair of a CSF leak between October 2004 and May 2009. Twenty-eight consecutive patients underwent 32 procedures. Twenty-two of the patients were women, which represents a statistically significant trend toward the female sex (p < 0.05). The average body mass index (33.9) was significant for obesity. The origin of the skull base defect included the cribriform plate (in 9 cases), fovea ethmoidalis (in 7), combined fovea ethmoidalis/cribriform plate (in 2), lateral sphenoid sinus (in 6), sella (in 4), clivus (in 3), and frontal sinus (in 1).

Results

The overall endonasal closure rate was 93.8% (30 of 32 procedures). One failure occurred due to overaggressive postoperative debridement, while the other recurred along the posterior wall of the frontal sinus, and endoscopic repair would have occluded the recess.

Conclusions

The endoscopic endonasal approach for the treatment of CSF leaks and encephaloceles of the anterior skull base is the preferred method of repair in the vast majority of cases. The authors' 93.8% closure rate in a variety of anatomical locations compares favorably with the transcranial approach and echoes the results of other endoscopic series.

Abbreviations used in this paper: BMI = body mass index; VP = ventriculoperitoneal.

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Contributor Notes

Address correspondence to: Theodore H. Schwartz, M.D., Department of Neurological Surgery, Weill Cornell Medical College, New York Presbyterian Hospital, 525 East 68th Street, Box #99, New York, New York 10065. email: schwarh@med.cornell.edu.

Please include this information when citing this paper: published online November 20, 2009; DOI: 10.3171/2009.10.JNS08986.

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