title: Determinants of success in endoscopic cerebrospinal fluid leak repair.
abstract: OBJECTIVE
  To identify factors influencing success in endoscopic repair of CSF leaks of the anterior skull base.
  
  
  METHODS
  Through retrospective chart review, 24 endoscopic closures of anterior skull base CSF leaks were analyzed for factors correlating with initial repair outcome.
  
  
  RESULTS
  Thirteen patients with either spontaneous leaks or iatrogenic leaks arising from FESS were repaired with significantly lower recurrence rate (8%) than 11 patients with leaks induced by skull base procedures (45%). However, in the latter group, only 14% recurred when the dural defect was directly visualized, whereas leaks always recurred when bony dehiscences were patched in the absence of visible dural defects. Such defects were least frequently localized in patients with craniotomy-induced leaks. A trend toward morbid obesity was also noted among repair failures.
  
  
  CONCLUSIONS
  Direct visualization of the dural defect is essential for endoscopic repair of anterior skull base CSF leaks, with craniotomy-induced leaks being the most challenging to localize. Obesity is another likely factor contributing to repair failure.
authors.affiliation: Department of Otorhinolaryngology-Head and Neck Surgery, University of Pennsylvania Health System, Philadelphia, Pennsylvania, USA. devbasu@sbcglobal.net
authors.forename: Devraj
authors.initials: D
authors.lastname: Basu
authors.forename: Bruce H
authors.initials: BH
authors.lastname: Haughey
authors.forename: James M
authors.initials: JM
authors.lastname: Hartman
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D004724:Endoscopy; D005260:Female; D006801:Humans; D007049:Iatrogenic Disease; D008297:Male; D008875:Middle Aged; D009765:Obesity / Q000150:complications; D019291:Skull Base / Q000601:surgery; D013353:Subdural Effusion / Q000601:surgery*; D016896:Treatment Outcome