Cerebrospinal Fluid Leak Repair Research Articles

Olfactory changes after endonasal endoscopic cerebrospinal fluid fistula repair: long-term outcomes.

This study aimed to evaluate odour measurements after endoscopic repair of cerebrospinal fluid fistulas. Demographic characteristics, cerebrospinal fluid leak location, surgical procedure, aetiology and smell test results were retrospectively reviewed. A total of 27 patients were included. The mean age was 43.52 years. The aetiology was spontaneous in 13 patients (48.1 per cent) and traumatic in 14 patients (51.9 per cent). The skull base defect was at the cribriform plate in 15 patients (55.6 per cent), the frontal sinus posterior wall in 4 patients (14.8 per cent), the sphenoid sinus posterior wall in 4 patients (14.8 per cent), around the anterior ethmoid artery in 2 patients (7.4 per cent), at the ethmoid roof in 1 patient (3.7 per cent) and at the sphenoid sinus posterolateral wall in 1 patient (3.7 per cent). After the comparison of pre-operative and post-operative values in identification, discrimination and threshold categories, a statistically significant difference was seen only in the threshold category (p = 0.014). The results demonstrated that endoscopic repair of cerebrospinal fluid leak is safe in terms of olfactory functions.

Outcomes of transnasal endoscopic repair of cerebrospinal fluid leaks: a prospective cohort study

BackgroundAlthough cerebrospinal fluid (CSF) leak repair of the anterior and middle skull base defect by endonasal endoscopic surgery (EES) presents one of the more difficult challenges, it has shown high success rates with less morbidity. Our objective is to evaluate the outcomes of transnasal endoscopic repair of CSF leak regarding success rate, impact on olfaction, and sinonasal function.MethodsA prospective cohort study was conducted to evaluate the CSF leak repair outcomes related to the site, size of the defect, surgical techniques, and the materials that been used through Smell Identification Test (SIT), 22-item Sino-Nasal Outcome Test (SNOT-22), Perioperative Sinus Endoscopy score (POSE), and Lund-MacKay Scoring (LM) of CT scan.ResultsTwenty-one patients were enrolled in the study; 12 out of 21 were females with a higher prevalence of traumatic causes of 61.9%. Different techniques and materials were used for the repair with a success rate recorded at 90.5% after the first closure attempt. The mean standard deviation (SD) scores postoperatively (after 6 months) was markedly decreased in SNOT 22 with mean (SD) 5.55 ± 3.6, slightly increase in POSE (mean ± SD = 0.43 ± 0.6), and slightly decrease in SIT (mean ± SD =10.31 ± 4.7) and LM (mean ± SD = 0.57 ± 0.7).ConclusionTransnasal endoscopic CSF leak repair is an effective technique for skull base defect closure with a high success rate and no valuable morbidity to sinonasal function other than mild hyposmia in patients where nasoseptal (NSF) and septal flap have been used.Trial registrationThe study was approved by the institutional review board and ethics committee of (The Arab Board of Health Specializations) with order no. (453) on 1April 2018.

Surgical Repair of Skull Base CSF Leaks after Cisternography Diagnosis: Analysis of Validity and Surgical Outcome and Impact on Future Treatment Strategies.

Skull base cerebrospinal fluid (CSF) leaks can lead to severe complications and require appropriate diagnosis and treatment. Cisternography is applied when exact localization via conventional imaging is not successful. The present study is aimed at identifying factors with potential impact on radiological results and surgical success. Cisternography followed by surgical repair due to skull base CSF leaks was performed in 63 cases between 2002 and 2020. The clinical and radiological findings were analyzed retrospectively. The etiology of CSF leaks was traumatic in 30.2%, spontaneous in 36.5%, and iatrogenic in 33.3%. The sensitivity of cisternography was 87.9%. Spontaneous CSF leaks tended to be diagnosed less frequently via cisternography and were significantly less frequently localized intraoperatively. The median postoperative follow-up period was 34 months. The primary surgical success rate was 79.4%, with a significantly higher success rate for lateral than for anterior skull base defects. Surgical failure tended to be lower in iatrogenic and higher in traumatic defects. Cisternography proved to be a highly sensitive method to localize skull base CSF leaks and can be recommended for advanced diagnostics. Iatrogenic leaks seemed to be more likely to have a favorable surgical outcome, whereas traumatic leaks tended to have a lower surgical success rate.

Middle Fossa Craniotomy for Repair of Cerebrospinal Fluid Leak and Plugging of Superior Semicircular Canal: 2-Dimensional Operative Video.

Deep, Nicholas L. MD*; Turcotte, Evelyn L. BS‡,§,‖; Bendok, Bernard R. MD, MSCI*,‡,§,‖,¶ Author Information

Venous sinus stenting after repair of skull base spontaneous cerebrospinal fluid leaks: a single-center retrospective cohort series with case-control analysis

Managementof idiopathic intracranial hypertension (IIH) is recommended after surgical repair of spontaneous cerebrospinal fluid leaks (sCSF-leaks) of the skull base for prevention of recurrence.Purpose: To assess the feasibility of venous sinus stenting, a treatment commonly used for the treatment of IIH associated with intracranial venous sinus stenosis (VSS), after sCSF-leaks closure. Asingle-center cohort series of consecutive patients who underwent sCSF-leak closure was retrospectively analyzed. Stenting was considered either for leak recurrence or in prophylactic manner after repair in patients with VSS as confirmed by cerebral venous imaging. Leak recurrence, need for new repair or adjunctive treatment of IIH, meningitis, and stenting complications were determined at the last follow-up. Cases who had prophylactic stenting were compared to historical controls before stenting option. Twenty-twopatients had intracranial venous stenting after sCSF-leak closure. Their median age was 58 years (Q1=45; Q3=68), BMI=31 kg.m-2 (Q1=27; Q3=36), and female rate=85%. The overall rate of successful repair after stenting was 95% (95% CI = 87-100%) at a median follow-up of 2.4 years (Q1=1.2; Q3=3.3). Adjunctive treatment for IIH was needed in 4 patients (4/22, 18%) including 2 patients without leak recurrence. No meningitis, permanent morbidity or mortality was observed after stenting. Compared to 18 controls, cases had significantly less recurrence (P = 0.03), and a trend for less adjunctive treatment for IIH (P = 0.06). Our study suggests that stenting might be a valid option for prevention of sCSF-leak recurrences after repair in patients with intracranial venous sinus stenosis. Déclaration de liens d'intérêts Les auteurs n'ont pas transmis leur déclaration de liens d'intérêts.

Comparison of Outcomes of Surgical Repair of Spontaneous Temporal Bone CSF Leaks and Encephaloceles Using Bone Cement and Autologous Material.

To compare outcomes transmastoid repair of spontaneous middle fossa cerebrospinal fluid (CSF) leak using only bone cement (BC) versus only autologous material (AM) or combined materials (CM) with both bone cement and autologous material. Retrospective Chart Review. Tertiary Care Hospital. Forty-three adult patients undergoing transmastoid repair of spontaneous middle fossa CSF leak between 2014 and 2020 (BC:12, AM:15, CR:16). Cortical mastoidectomy, identification of defect, and repair with BC (Cranios® hydroxyapatite), AM (local bone, fascia, fat, and/or cartilage), or CM (Cranios® combined with autologous materials). Successful repair without recurrent CSF leak or encephalocele throughout follow up. Fifty-one percent of subjects were female. Mean age at repair was 58.6 years (SD 10.9). Mean BMI was 35.4 (SD 7.6; BC:36.3, AM:36.5, CM:33.6). Forty (93%) patients had successful repair without known recurrent CSF leak or encephalocele since surgery (BC:11, 91.6%; AM:14, 93.3%; CM:15, 93.8%; p = 0.49) over a mean length of follow up of 49.6 months (BC: 37.9, AM: 59.2, CR: 49.5). The difference in mean operative time amongst the groups was faster for patients using bone cement (BC: 100.2 min, AM: 182.8, CM: 133.2; p < 0.00001). BC, AM, and CM techniques each demonstrate effective and sustained means of repair for middle fossa CSF leak and encephalocele, even in the presence of multiple defects. Use of isolated BC offers a significant decrease in operative time with a noninferior outcome. Active CSF leak at the time of surgery is associated with increased risk of recurrence.

Endoscopic Repair of Spontaneous Cerebrospinal Fluid Leaks in the Lateral Recess of the Sphenoid Sinus.

This study aimed to assess the effectiveness of 3 endoscopic endonasal approaches for the management of cerebrospinal fluid (CSF) leaks and meningoencephaloceles in the lateral recess of the sphenoid sinus (LRSS). Retrospective study. University hospital. This study retrospectively reviewed 49 patients with CSF leaks and meningoencephaloceles in the LRSS. Three endoscopic surgical repair approaches were indicated based on 5 different Rhoton's types of the LRSS. The postoperative symptoms, complications, and follow-up outcomes were investigated and evaluated. The success rate of endoscopic surgical repair was 100% at a median follow-up of 75.06 (12-203.4) months. Endoscopic approaches to the LRSS included the prelacrimal recess (PLR) (18.37%), transsphenoidal (18.37%), and transpterygoid approaches (64.26%). All patients in the PLR approach (PLRA) group and most of the patients in the transpterygoid approach group had a full lateral type LRSS. Hypoesthesia and dry eyes were reported in 5 patients (55.56%) and 1 (11.12%) patient, respectively, from the PLRA group and in 6 (19.35%) and 5 (16.12%) patients, respectively, from the transpterygoid approach group. Endoscopic closure is a safe and effective method for the treatment of CSF leaks and meningoencephaloceles in the LRSS. The transpterygoid approach and PLRA offer adequate exposure of the LRSS with extensive lateral pneumatization or a full LRSS. The endoscopic route of the PLRA is more direct than that of the transpterygoid approach. Careful preoperative imaging evaluation is crucial while selecting the optimal surgical approach for the repair of a skull base defect.

Cerebrospinal Fluid Leak Repair: Usefulness of Intrathecal Fluorescein for Correct Topographic Identification of the Skull Base Defects

In the management of cerebrospinal fluid (CSF) leak, the identification of the exact discharge spot is paramount. This process can represent a challenge for the radiologist and the surgeon. In the present study, we analyzed a series of patients affected by endonasal CSF leak who underwent endoscopic surgical reconstruction aided by the use of ITF. The purpose of this work is to assess the efficacy of intraoperative ITF in addition to computed tomography (CT) and magnetic resonance imaging for correct topographic localization of the CSF leak. Eighty-three patients were enrolled in the study. The main outcome was the concordance between the supposed radiologic defect site and the actual one seen intraoperatively. Recurrence-free survival was evaluated as secondary outcome. ITF better defined the defect site, allowing a change in the treatment in 21 patients (25.3%), in whom nonconcordance was observed between the suspected radiologic site and the actual surgical site. Good agreement was found between the specific topographic localization (κ= 0.737; P < 0.0001), whereas fair agreement was observed considering the side of the defect (κ= 0.362; P= 0.0009) and correct identification of multiple sites (κ= 0.044; P= 0.666). The 10-year 96% estimate of recurrence-free survival confirmed the correct repair of the fistula site in most cases. Our data show the usefulness and safety of intraoperative ITF for management of patients affected by endonasal CSF leak. ITF improved the topographic diagnosis of the leak site, ensuring the best target reconstruction and very low recurrence rate.

Assessing the utility of intrathecal fluorescein in endoscopic repair of anterior skull base cerebrospinal fluid leaks.

Assessing the utility of intrathecal fluorescein in endoscopic repair of anterior skull base cerebrospinal fluid leaks.

Fibrin glues — the current state of knowledge

Fibrin glue is a two-component biological material obtained as result of extemporaneous preparation of equal volumes of fibrinogen concentrate and thrombin solution. On a mass scale fibrin glue is acquired either commercially by way of plas ma fractionation, or in laboratory setting by chemical precipitation or cryoprecipitate method. Fibrin glue mimics the blood clotting mechanism. Thrombin converts fibrinogen into fibrin clot, which — due to hemostatic properties contributes to sealing the wound and supporting damaged tissue regeneration. The clot adheres to adjacent tissues, and the structure becomes a natural scaffold for precursor and effector cells as well as hematopoietic growth factors that actively promote wound healing. Fibrin glue has found application as wound sealant mostly for patients with coagulation factor deficiencies and problems with spontaneous wound repair. The material is commonly used i.a. in general surgery (wound sealing or vascular suture ), regenerative surgery (bone implant fixation), plastic surgery (better cosmetic results, prevention of unaesthetic scarring), skin tissue regeneration for burn injury, neurosurgery (prevention of cerebrospinal fluid leak and nerve repair), cardiovascular surgery and stomatology. Fibrin glue embedded with drugs, antibiotics, cytostatic agents or stem cells, may increase the effectiveness of therapy and facilitate targeted delivery of active substances for localized drug release. The aim of the article is to present the current state of knowledge on the methods of preparation and application of fibrin sealants as well as on other possible use in various fields of medicine.

Sinonasal Packing is Not a Requisite for Successful Cerebrospinal Fluid Leak Repair.

Background Numerous methods have been described to repair nasal cerebrospinal fluid (CSF) leaks. Most studies have focused on optimizing CSF leak repair success, leading to closure rates of 90 to 95%. Objective This study aimed to determine if excellent reconstruction rates could be achieved without using sinonasal packing. Methods A prospective case series of 73 consecutive patients with various CSF leak etiologies and skull base defects was conducted to evaluate reconstruction success without sinonasal packing. The primary outcome measure was postoperative CSF leak. Secondary outcome measures were postoperative epistaxis requiring intervention in operating room or emergency department, infectious sinusitis, and 22-item sinonasal outcome test (SNOT-22) changes. Results Mean age was 54.5 years and 64% were female. Multilayered reconstructions were performed in 55.3% of cases, with collagen or bone epidural inlay grafts, and nasal mucosal grafts or nasoseptal flaps for onlay layers. Onlay-only reconstructions with mucosal grafts or nasoseptal flaps were performed in 44.7% of cases. Tissue sealants were used in all cases, and lumbar drains were used in 40.8% of cases. There were two initial failures (97.4% initial success), but both resolved with lumbar drains alone (no revision surgeries). There were no instances of postoperative epistaxis requiring intervention in the operating room or emergency department. Infectious sinusitis occurred in 2.7% of patients in the first 3 months postoperatively. SNOT-22 did not change significantly from preoperatively to first postoperative visits, then improved over time. Conclusion Nasal CSF leaks from various etiologies and defect sites were successfully repaired without using sinonasal packing, and patients experienced minimal sinonasal morbidity.

351 Anterior Ethmoid Artery Septal Flap for Endoscopic Reconstruction of Frontal Sinus CSF Leak

Abstract Introduction Anterior skull base cerebrospinal fluid (CSF) leaks are managed successfully with endonasal surgery. Endoscopic closure of CSF leaks from posterior table of the frontal sinus remains challenging. Vascularized Hadad-Bassagasteguy flap (HBF) reconstruction of the skull base has increased CSF closure rates but does not extend to frontal sinus. We describe our technique using septal flap pedicled by anterior ethmoid artery (AEA) for repairing frontal defects. Method Retrospective review of cases of frontal CSF leak repair using the AEA flap reconstruction. Flap design: an anterior vertical septal mucosa incision at posterior border of the frontal sinusotomy is made and extended to nasal floor. Posterior vertical incision is made 1 cm posterior to the projection of the axilla of the middle turbinate on the septum and extended to nasal floor. A horizontal incision along the nasal floor joins the two incisions. The flap is raised and rotated into the frontal sinus over the posterior table reconstructed defect. Results Three patients identified. Two males, one female, aged 11, 33 and 56. Patient histories included recurrent bacterial meningitis following head trauma, recurrent sinusitis and fronto-ethmoidal osteoma, with intraoperative CSF leak and CSF rhinorrhea due to meningoencephalocele. The three posterior wall defects were successfully repaired endoscopically with multilayer reconstruction and the AEA septal flap. Conclusions The anterior ethmoid artery septal flap can be successfully utilised for frontal CSF leak repair. Flap is conveniently located for frontal sinus defects. When the septum is intact it provides an excellent final layer as part of multilayer reconstruction.

Transnasal Endoscopic Surgical Repair of Cerebrospinal Fluid(CSF) Rhinorrhea by Inferior Turbinate Grafts

Objective: The study aims to evaluate the outcomes of transnasal endoscopic surgical repair of CSF rhinorrhoea.Materials and Methods: After approval from the institutional ethical committee (DME-396-18) and patient consent, a descriptive study of 27 patients with cerebrospinal fluid rhinorrhea was conducted at Aziz Fatimah Trust Hospital Faisalabad from August 21, 2018, to February 7, 2021. Transnasal endoscopic surgical repair of Cerebrospinal fluid leak was performed by using multilayer technique using a graft from the inferior turbinate. The data collected were analyzed using SPSS 20.Results: The most common site of the CSF leak was the left side of the cribriform plate (n=19,70%). The most common etiology was spontaneous (n=16,59%). At the same time, traumatic CSF leak (n=16,59%). was the second common etiological factor. The surgical procedure used in the study reported a 93%(n=25) success rate. The success rate was 97.5% on revision surgeries.Conclusion: Transnasal endoscopic surgical repair of CSF leak is one of the most effective and safe surgical interventions. Multilayer technique is not only safe but also has lesser complications. Moreover, this minimizes the risk for the development of secondary wounds as compared to other surgical processes.

Outcome of the endoscopic repair of frontal sinus cerebrospinal fluid leak

Introductionand Objectives: Leakage of cerebrospinal fluid (CSF) from the frontal sinus is a challenging condition facing the ENT surgeon. Repair of this condition has been changed nowadays due to the newer instruments and techniques of nasal endoscopy. This study aims to evaluate the outcome of frontal sinus CSF leak endoscopic repair. Patients and methodsTwenty-seven patients who had frontal sinus CSF leaks were included in this study. They were 9 females and 18 males. They underwent endoscopic repair of the leak site at the period of five years from 2015 to 2020. A retrospective evaluation of these patients includes reconstructive procedures, complications, and postoperative follow-up. ResultsThe frontal leaks were present in the frontal recess (8 patients, 29.6%), ethmoidal roof (5 patients, 18.5%), and the majority was in the posterior wall (14 patients, 51.9%); 11 in the medial side and 3 in the lateral side. All cases, 27 (100%) were treated successfully, no failed treatment was observed. Postoperative complications were minimal; two patients had elevated intracranial pressure (ICP), infection with fever were found in four patients (7.4%), and meningitis was observed in only two cases (7.4%), treated conservatively. ConclusionFor frontal sinus CSF leak repair, the endonasal endoscopic approach is the treatment of choice due to higher success rates and lower morbidity profile. A favorable result is possible with proper diagnosis, precise localization, and an appropriate strategy.

Combined Endoscopic Transsphenoidal and Tubular Retractor-Assisted Transventricular Approach for Giant Pituitary Adenomas

Surgical resection remains the standard treatment for most giant pituitary adenomas (GPAs). The selected surgical approach for these complex lesions depends mainly on their extension. Single approaches may be limited in some cases presenting with invasion into multiple compartments, thereby limiting extent of resection. We report a series of patients with GPA operated on through a combined approach involving an endoscopic endonasal transsphenoidal approach and a tubular retractor-assisted transventricular approach, describing the technique, its indications, limitations, and outcomes. Baseline and postoperative clinical, functional, and morphologic variables were documented up until each patient's last follow-up visit. Five patients harboring tumors extending into the third and lateral ventricles were included. Mean extent of resection was 94.6%. Mean follow-up was 39.4 months. One patient presented with a growth hormone-secreting GPA, who achieved remission after repeat resection during follow-up. There were no intraoperative complications, and 1 patient required reoperation for cerebrospinal fluid leak repair. One patient received adjuvant radiotherapy, and 3 patients remained stable requiring no additional treatment. All patients maintained an adequate postoperative functional status. The combined approach herein described may be a safe and effective option for some patients with GPAs extending into the third and lateral ventricles. An adequate patient selection is mandatory to exploit the benefits of each individual approach.

A Novel Protocol for Reducing Intensive Care Utilization After Craniotomy.

There is a growing body of evidence suggesting not all craniotomy patients require postoperative intensive care. To devise and implement a standardized protocol for craniotomy patients eligible to transition directly from the operating room to the ward-the Non-Intensive CarE (NICE) protocol. We preoperatively identified patients undergoing elective craniotomy for simple neurosurgical procedures with age <65 yr and American Society of Anesthesiologists (ASA) class of 1, 2 or 3. Postoperative eligibility was confirmed by the surgical and anesthesia teams. Upon arrival to the ward, patients were staffed with a neuroscience nurse for hourly neurological examinations for the first 8 h. Patient demographics, clinical characteristics, and outcomes were prospectively collected to evaluate the NICE protocol. From February 2018 to 2019, 63 patients were included in the NICE protocol with a median age of 46 yr and 65% female predominance. Of the operations performed, 38.1% were microvascular decompressions, 31.7% were craniotomy for tumor, 15.9% were cavernous malformation resections, and 14.3% were Chiari decompressions. No patients required transfer to the intensive care unit (ICU). Median length of stay was 2 d. There was an 11.1% overall readmission rate within the median follow-up period of 48 d. Three patients (4.8%) required reoperation at time of readmission within the follow-up period (1 postoperative subdural hematoma, 2 cerebrospinal fluid leak repair). None of these complications could have been identified with a postoperative ICU stay. In our pilot trial of the NICE protocol, no patients required postoperative transfer to the ICU.

Endoscopic endonasal management of skull base defects in pediatric patients

PurposeSkull base defects in children may be the result of congenital anomalies or trauma. They often present as cerebrospinal fluid (CSF) rhinorrhea, meningitis, brain abscess or nasal obstruction. Surgical intervention is predominantly the treatment of choice. Our goal is to assess the efficacy of endoscopic endonasal approach in treating skull base defects in pediatric patients. Material and methodsIn this retrospective study we identified 38 patients (mean age 8.7 ± 5.6 years old, ranging 2 months-18 years) who underwent endoscopic endonasal repair of skull base defects, between March 2010 and February 2020. Patients who had skull base reconstruction after tumor resection, those who were lost to follow-up or did not sign the consent forms were excluded from the study. ResultsThe clinical indications for endoscopic endonasal repair were trauma (n = 24, 63.1%) and congenital defects (n = 14, 36.9%). Congenital skull base defects included basal meningoencephalocele (n = 5, 35.7%) and frontoethmoidal defects (n = 9, 64.3%). Mean follow up time was 32 ± 29.04 months, ranging 2–103 months. Fat graft (alone or in combination) was the most commonly used material to repair the skull base defects. Thirty-seven patients (97%) showed successful results after endoscopic endonasal surgery and were symptom free. ConclusionThe endoscopic endonasal repair of CSF leak and skull base defects proved to be safe and feasible with 97% success rate.

Compare the Outcome of Endoscopic Endonasal versus Transcranial Approach for Cerebrospinal Fluid Leak Repair

Objective: The aim of this study is to compare the outcome of endoscopic endonasal verus transcranial approach for cerebrospinal fluid leak repair. Study Design: Comparative study Place and Duration: Conducted at department of Neurosurgery, Mardan Medical Complex/ Bacha Khan Medical College, Mardan during the period from 1st January 2020 to 31st December 2021. Methods: Total eighty patients of both genders were presented in this study. Patients were aged between 20-65 years. Patients’ detailed demographics age, sex and body mass were recorded after taking written consent. Patients had CSF leaks and the history of CSF leak was presented. Patients were equally divided into two groups, I and II. Group I received endonasal technique and group II received transcranial approach. All the patients underwent MRI and CT scan. Complete follow up among both groups were taken in the duration of 8 months for the assessment of efficacy. Complete data was analyzed by SPSS 24.0 version. Results: Mean age of the patients in group I was 33.08±14.90 years with mean BMI28.4±3.12 kg/m2 and in group II mean age was 31.66±4.84 years with mean BMI 27.45±1108 kg/m2. Total 50 (62.5%) patients were males (25 in each group) and 30 (37.5%) patients were females (15 in each group). In group I recurrence rate was found in 3 (7.5%) cases and in group II recurrence rate was 6 (15%). 3 (7.5%) patients in group II developed infection but no infection rate was found in the endoscopic endonasal group. Satisfaction among patients in the endonasal group was greater than that of the transcranial group. Overall efficacy rate among both groups was 71 (88.8%). Conclusion: We concluded in this study that for repair of cerebrospinal fluid leak endoscopic endonasal approach was effective and safe method as compared to transcranial approach. Minimum rate of recurrence and high rate of recovery was fund in endonasal approach. Keywords: CSF, Endoscopic endonasal, Transcranial approach, Complications, Recurrence

Venous sinus stenting after repair of skull base spontaneous cerebrospinal fluid leaks: A single-center retrospective cohort series with case-control analysis

BackgroundManagement of idiopathic intracranial hypertension (IIH) is recommended after surgical repair of spontaneous cerebrospinal fluid leaks (sCSF-leaks) of the skull base for prevention of recurrence. PurposeTo assess the feasibility of venous sinus stenting, a treatment commonly used for the treatment of IIH associated with intracranial venous sinus stenosis (VSS), after sCSF-leaks closure. Materials and methodsA single-center cohort series of consecutive patients who underwent sCSF-leak closure was retrospectively analyzed. Stenting was considered either for leak recurrence or in prophylactic manner after repair in patients with VSS as confirmed by cerebral venous imaging. Leak recurrence, need for new repair or adjunctive treatment of IIH, meningitis, and stenting complications were determined at the last follow-up. Cases who had prophylactic stenting were compared to historical controls before stenting option. ResultsTwenty-two patients had intracranial venous stenting after sCSF-leak closure. Their median age was 58 years (Q1=45; Q3=68), BMI=31 kg.m−2 (Q1=27; Q3=36), and female rate=85%. The overall rate of successful repair after stenting was 95% (95% CI = 87–100%) at a median follow-up of 2.4 years (Q1=1.2; Q3=3.3). Adjunctive treatment for IIH was needed in 4 patients (4/22, 18%) including 2 patients without leak recurrence. No meningitis, permanent morbidity or mortality was observed after stenting. Compared to 18 controls, cases had significantly less recurrence (P = 0.03), and a trend for less adjunctive treatment for IIH (P = 0.06). ConclusionsOur study suggests that stenting might be a valid option for prevention of sCSF-leak recurrences after repair in patients with intracranial venous sinus stenosis.

Endonasal Endoscopic and Hybrid Surgery Techniques for Blunt Trauma Fractures of the Skull Base With Cerebrospinal Fluid Leaks.

Cerebrospinal fluid (CSF) leakage caused by skull base fracture represents high risks of bacterial meningitis, and a rate of mortality of 8.9%. Endoscopic endonasal repair of CSF leaks is quite safe and effective procedure with high rates of success. The aim of this study is to describe our technique for management of skull base CSF leaks secondary to craniofacial trauma based on the anatomic location of the leak. This is a retrospective case series of 17 patients with diagnosis of craniofacial trauma, surgically treated with sole endonasal endoscopic and combined endonasal/transcranial approaches with diagnosis of CSF leak secondary to skull base fractures. Seventeen patients met inclusion criteria for this study. Mean age was 46 years old. Most common etiology was motor vehicle. Early surgery was performed in 8 patients, and late surgery in 9 patients. The most common site of CSF leak was at ethmoid cells or at the fronto-ethmoid junction in 9 patients. Thirteen patients (76.4%) were treated only with endonasal endoscopic technique, and 4 (23.5%) with hybrid surgery, combining endonasal endoscopic and cranial bicoronal approaches with nasal and pericranial vascularized flaps, and nasal mucosal free flaps. Mean hospital stay was 23.7 days.The mean follow-up time was 25.6 months. When surgical reconstruction is indicated for CSF leaks secondary to skull base fractures, endonasal endoscopic techniques should be part of the surgical management either as a sole procedure, or in combination with classical transcranial approaches with high rates of success and low morbidity.