Endoscopic repair of cerebrospinal fluid leaks to the sinonasal tract: Predictors of success

INTRODUCTION: Cerebrospinal fluid (CSF) leaks may arise as a complication of endoscopic sinus surgery, trauma, or hydrocephalus, or they may occur spontaneously without any identifiable cause. Despite general agreement that CSF leaks should not be left untreated, their initial management, the surgical indications, and the technique of repair are controversial. OBJECTIVE: We undertook this study to ascertain whether a particular surgical technique or material was more successful for repair. Additionally, we tried to identify which specific characteristics of the patient, the CSF fistula, or the adjunctive treatment influenced the result of the repair. STUDY DESIGN: We completed a retrospective review of all patients undergoing endoscopic repair of a CSF leak at our academic hospitals. RESULTS: Forty-eight patients with 53 CSF fistulas were included in the study. Fifty sites were successfully repaired endoscopically on the first attempt. Three persistent leaks were repaired successfully on the second attempt. Location and size of the leak, cause, technique, and choice of material used for the repair did not significantly affect surgical outcome. However, the presence of hydrocephalus had a statistically significant negative influence on surgical outcome. All patients with increased intraventricular pressure required a ventricular shunt in addition to a second endoscopic repair. CONCLUSION: if the surgical technique is sound, endoscopic repair of CSF leaks is highly successful, independent of the choice of the material and technique used in the repair.