ENDONASAL ENDOSCOPIC CLOSURE OF CEREBROSPINAL-FLUID FISTULAS AT THE ANTERIOR CRANIAL BASE

This study reports our indications and limits for endonasal endoscopic closure of dural defects with a cerebrospinal fluid (CSF) leak at the anterior cranial base, and demonstrates our surgical technique. Fifty -three patients with CSF rhinorrhea were reassessed for the success ra te of closure of the CSF leak. Surgery was successful in 98%, and 68% of fistulas were closed endoscopically. A free graft of autogenous muc operiosteum of the inferior turbinate was the most frequently used tis sue for defect closure. The endonasal endoscopic route proved relative ly safe for the closure of dural tears, irrespective of the cause, up to about 10 x 10 mm. It is characterized by minimal morbidity because of the preservation of sinus ventilation and bony structures, supraorb ital nerves, and olfactory fibers. Defects larger in size, predominant ly of traumatic origin, were closed via the transfacial approach. The decision on the surgical approach was additionally based on the extent of the facial soft tissue injuries and the localization of the leak.