Abstract
Background: Cerebrospinal fluid (CSF) rhinorrhea results from a skull base defect with disruption of the arachnoid, dura mater, and sinonasal mucosa, leading to CSF leakage through the nose. The purpose of this study was to compare CT and MRI findings and CSF leak location, and to evaluate the role of endoscopic repair in improving outcomes.
Methods: We retrospectively evaluated thirty patients with CSF leaks between January 2016 and August 2025, analyzing treatment decisions, the endoscopic endonasal approach, and neurosurgical outcomes.
Results: Twenty-two patients (14 male, 8 female) with CSF rhinorrhea underwent endoscopic endonasal skull base repair during the study period. Clinical features included headache in two-thirds of patients (n = 14, 63%), frequent meningitis (n = 6, 28%), focal neurologic symptoms (n = 5, 23%), and epileptic seizures (n = 5, 23%). The most common sites of skull base defect were the cribriform plate, ethmoid, and planum sphenoidale, in 12 (55%), 8 (37.7%), and 2 (9%) patients respectively. All patients underwent endoscopic endonasal repair followed by lumbar drain placement, uneventfully. Two referred patients developed meningitis after repair, which resolved with appropriate antibiotics. Endoscopic repair of CSF leaks is now the standard procedure given its minimally invasive nature.
Conclusion: The endoscopic endonasal approach is the best method for repairing CSF leaks, reducing morbidity and mortality.
