INTRODUCTION: Cerebrospinal fluid (CSF) leaks may arise as a complication o
f endoscopic sinus surgery, trauma, or hydrocephalus, or they may occur spo
ntaneously without any identifiable cause. Despite general agreement that C
SF leaks should not be left untreated, their initial management, the surgic
al indications, and the technique of repair are controversial.
OBJECTIVE: We undertook this study to ascertain whether a particular surgic
al technique or material was more successful for repair. Additionally, we t
ried to identify which specific characteristics of the patient, the CSF fis
tula, or the adjunctive treatment influenced the result of the repair.
STUDY DESIGN: We completed a retrospective review of all patients undergoin
g endoscopic repair of a CSF leak at our academic hospitals.
RESULTS: Forty-eight patients with 53 CSF fistulas were included in the stu
dy. Fifty sites were successfully repaired endoscopically on the first atte
mpt. Three persistent leaks were repaired successfully on the second attemp
t. 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 inf
luence on surgical outcome. All patients with increased intraventricular pr
essure required a ventricular shunt in addition to a second endoscopic repa
ir.
CONCLUSION: if the surgical technique is sound, endoscopic repair of CSF le
aks is highly successful, independent of the choice of the material and tec
hnique used in the repair.