CSF rhinorrhea: 95 consecutive surgical cases with long term follow-up at the Mayo Clinic

A persistent cerebrospinal fluid (CSF) leak is potentially lethal, and surg ical treatment is often required CSF leak repair is an infrequently perform ed procedure, and only limited information is available on the long term su ccess of the surgical techniques that are used. This retrospective chart re view includes 95 patients who underwent various types of repair surgery for CSF rhinorrhea at the Mayo Clinic. The purpose of this study was to extrac t factors such as the choice of sealing material, etiology, location of def ect(s), surgical approach, and previous procedures, and to analyze their as sociation with the long term success and failure of surgical repair. The me an time interval in this study between unsuccessful surgery and recurrence was 50.8 months, and the mean follow-up 109 months. Among the various appro aches, defects repaired endonasally had the lowest recurrence rate. Local n asal mucosa advancement flaps failed more frequently (83.3% failure) than o ther types of graft material (p = 0.023). These failures took place in a de layed fashion (mean interval until failure: 80 months). Local osteo-mucoper iosteal or chondro-mucoperichondrial flaps (22.2% recurrence rate) and free graft material (15.6% recurrence rate) had the best outcome. The use of fi brin glue to fixate free grafts did not improve the result in this series. Transcranial procedures were associated with a higher complication rate tha n extracranial procedures (12.9% versus 3.2%). Overall, successful repair w as achieved in 91.6% of the patients. We discourage the use of mucosa advan cement flaps and advocate free grafts or pedicled osteomucoperiosteal or ch ondro-mucoperichondrial flaps as sealing material of choice in the majority of cases. The occurrence of delayed failure has to be considered when eval uating reports of CSF rhinorrhea after surgical repair.