Skull base CSF leak repair in the outpatient Arena: Pushing the boundaries of modern endoscopic surgery.

BACKGROUND: Skull base defects with cerebrospinal fluid (CSF) leak have been a significant clinical challenge due to the risk of life-threatening complications such as meningitis, pneumocephalus and intracranial abscess formation. Traditionally, these defects have been managed in the operating room under general anesthesia, using either open craniotomy or endoscopic endonasal approaches. However, with advances in high-definition endoscopy, specialized instruments and biomaterials for reconstruction, there is a growing chance of performing selected repairs in an outpatient setting under local anesthesia. This approach has the potential to reduce healthcare costs, shorten recovery times, and enhance patient comfort without compromising safety or effectiveness. OBJECTIVE: To evaluate the outcomes, safety profile, and feasibility of office-based endoscopic endonasal skull base repair in a series of patients at King Faisal Specialist Hospital & Research Center, Jeddah, Saudi Arabia. METHODS: This retrospective case series included nine patients with postoperative CSF rhinorrhea who underwent office-based skull base repair between April 2024 and May 2025. All skull base repair procedures were performed under local anesthesia following a standardized protocol that involved defect identification, silver nitrate cauterization of defect margins, and multilayer overlay and/or underlay grafting using biomaterials such as oxidized regenerated cellulose, human fibrinogen, bovine serum albumin/glutaraldehyde, and/or surgical glue. In selected cases, nasal packing was used to reinforce the graft. Follow-up evaluations were performed at multiple intervals to assess leak resolution and identify any complications. RESULTS: Seven of nine patients (77.78%) experienced complete leak resolution after a single procedure. Two patients (22.22%) required a second in-clinic intervention, which successfully closed the defect. No postoperative infections, neurological deterioration, or surgical reinterventions were observed. Follow-up ranged from 2 to 43 months, with no signs of recurrence. CONCLUSION: Office-based endoscopic endonasal skull base repair is a safe, effective, and resource-efficient option when applied to carefully selected patients with low-volume postoperative CSF leaks. These findings support minimally invasive management of CSF leaks and highlight the importance of refined patient selection criteria, surgeon expertise and long-term follow-up for optimal outcomes.