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Endoscopic Repair of CSF Fistulas and Meningoencephaloceles

Objective: Spontaneous CSF fistulas are related with an alteration of the embryologic closure of the skull base, from a simple thinning of the duramater in the cribriform area or the fontanel to a meningoecephalocele anywhere in the skull base. Endoscopic skull base surgery has improved tremendously the morbidity and the postoperative care in these patients, in relation with a craniotomy. We present our experience in the Domingo Luciani Hospital and in Sanatrix Clinic treating these patients endoscopically with excellent results, without intensive care unit and just one day in the hospital. Method: Fifteen patients were operated with spontaneous CSF leak from 2004 to 2011, 4 of them were meningo or meningoencephaloceles, and the location were 1 in the frontal sinus, 1 in the lateral wall of the sphenoid, 6 in the cribriform plate, 5 in the fovea etmoidalis, and 2 in that planum sphenoidale. Results: The fistulas were repaired either with free graft, 1 layer or with 2 layers, cartilage and middle turbinate mucoperiosteum; just in 1 case we delivered a septal flap. Of the 15 patients, 13 resolved the leak completely, without any morbidity. In 2 of them the leak reappears when they stop the postoperative medication, with 86.7% success rate. Conclusion: Endoscopic repair of the CSF fistulas is safe, reliable, with little morbidity and with a very short stay in the hospital.