MICROSCOPIC ENDONASAL SURGERY FOR REPAIR OF CSF LEAKS

This manuscript will detail our experience using a microscopic endonasal surgery (MES) approach in the repair of spontaneous, traumatic, and/or iatrogenic cerebrospinal fluid (CSF) fistula into the ethmoid and sphenoid sinuses. The location of the fistula in 22 patients was determined by a direct endoscopic or microscopic visualization, intrathecal fluorescein, or computed tomography (CT) with metrizamide. Several of these patients had been treated unsuccessfully with previous neurosurgical, intracranial, and extracranial approaches to stop the leak. The CSF fistulas in all these patients were repaired with a MES approach, packing the leak with either a septal mucosal graft, or abdominal fat and fascia, and no external incisions were utilized. Furthermore, this approach allowed for an overall closure rate of 95% and offered a direct means to locate the fistula at the time of surgery. It also allowed for precise placement of grafts to cover the defect, an opportunity to perform bimanual dissection, and in general afforded an excellent field of vision.