Endoscopic Endonasal Cerebrospinal Fluid Leak Repair on the Ventral Midline Skull Base: A Single Neurosurgical Center Experience.
To present the results of endoscopic endonasal repair of ventral midline skull base cerebrospinal fluid (CSF) leak (VMSBL) at our institution and to discuss the technique and results from a neurosurgical perspective. A retrospective analysis of all VMSBL cases that underwent endoscopic endonasal skull base approach (EESBA) for CSF leak repair at a single tertiary neurosurgical center was performed. Twenty six patients with an average age of 44.4 (range: 17-63) years were included in the study. The etiology of VMSBL was spontaneous in 16 patients, traumatic in 7, and iatrogenic in 3. The leakage site was the cribriform plate in 13 patients, ethmoidal cells in 7, and sphenoid sinus in 3. There were multiple leaks in 3 patients. This approach for VMSBL repair was performed 28 times on 26 patients. The success rate was 88.5% (23/26 patients) after primary endoscopic repair and 96% after the second attempt. The location of the leakage site relative to the upper attachment of the middle turbinate played a crucial role in the anteriorly located VMSBL, which made an impact on the surgical repair plan. All the 16 cases with accompanying meningoencephaloceles were treated successfully by EESBA. Use of vascularized pedicled flaps to support the repair site resulted in 100% success after primary repair. EESBA is safe and highly effective and can be a first-line surgical treatment option for VMSBL. In addition, it enables adequate reconstruction of ventral midline skull base meningoencephaloceles regardless of size and location.