Endoscopic cerebrospinal fluid leak closure in an infected field.

BACKGROUND

Sinonasal cerebrospinal fluid (CSF) leaks during an active infection present the unique challenge of preventing spread of infection without compromising the integrity of the closure. We describe the technique and clinical course of patients undergoing endoscopic CSF leak repair in an actively infected field.

OBJECTIVE

To evaluate the safety and efficacy of endoscopic CSF leak repair in an actively infected field.

METHODS

Retrospective chart review of patients with sinonasal CSF leaks that were endoscopically repaired during an acute infection.

RESULTS

Nine patients were identified. Etiologies of CSF leak were iatrogenic after endoscopic sinus surgery (n = 5, 55.6%) or revision craniopharyngioma resection (n = 1, 11.1%), spontaneous (n = 1, 11.1%), anterior skull base meningocele with CSF leak (n = 1, 11.1%), and posttraumatic (n = 1, 11.1%). The locations of the leaks were ethmoid in five patients, frontoethmoid in three patients, and sphenoid in three patients. Seven patients had acute sinusitis (77.8%) and two patients had meningitis (22.2%) at the time of closure. Two patients (22.2%) had failure of previous CSF leak closure. All leaks were repaired in a multilayered fashion with multiple graft types, including septal or conchal cartilage, temporalis fascia, fascia lata, fat, Medpor, and tissue sealant. Three patients additionally had mucosal flaps or grafts. The patients were treated with an average of 11.1 days (range, 6-14 days) of antibiotics. The average hospital stay was 4.1 days (range, 2-7 days), and the mean follow-up time was 8.7 months (range, 2.9-19.3 months). No patients experienced recurrence of CSF leak or postoperative complication or infection.

CONCLUSION

Endoscopic closure of skull base defects was successfully performed in nine patients during acute infections without complications, recurrent infection, or need for revision CSF leak closure. Endoscopic CSF leak repair appears to be safe and effective in patients with active infection with sinusitis or meningitis.