The Key Methods to Increase the Success Rate of Endoscopic Repair of Cerebrospinal Fluid Rhinorrhea

Abstract

Objectives: To evaluate the success rate of endoscopic repair of CSF leak and factors with potential effect on surgical outcome. Methods: A case series study based on review of medical records and follow up of patients admitted at three hospitals during a 5 year period. Results: Of 43 operated patients 38 (88.4%) had successful result after first surgical attempt. Defect size, number of graft layers, graft placement technique-underlay vs. overlay-lumbar drain placement or serial lumbar punctures did not show a statistically significant association with surgical outcome. Definite determination of defect site before or during operation had a relationship with surgical success with a P value of 0.06 there was a significant correlation between the number of layers on the defect site and immediate postoperative improvement. Conclusions: Endoscopic repair of CSF leak has been proven as a successful method with reported success rate of above 80 percent. Careful attempt to find the exact site of CSF leak is recommended. We do not suggest the routine use of lumbar drains, serial post op lumbar punctures and intrathecal fluorescine due to their potential complications and no evidence for their efficacy.