Anterior skull base cerebrospinal fluid fistulas in Puerto Rico: treatment and outcome.
BACKGROUND
The surgical management of anterior skull base cerebrospinal fluid (CSF) fistulas has evolved throughout the last decade. Endonasal endoscopic surgery of the anterior skull base has become the standard procedure for the repair of most these fistulas.


OBJECTIVE
To describe the presenting symptoms, etiology, treatment, and long-term outcomes of patients with anterior skull base CSF fistulas treated endoscopically at our institution. MATERIAL/ METHODS: Retrospective analysis of 25 patients with CSF fistulas treated endoscopically at the University of Puerto Rico Hospital from November 2004 to August 2008.


RESULTS
The etiology was spontaneous leak in 10 patients, menigoencephalocele in 7 patients, previous sinus surgery in one patient, and trauma in one patient. The most common location of leak was the cribiform plate, followed by the ethmoid roof. An overlay technique was used for repair in 61% of the procedures versus 39% for the underlay technique. The mean follow up was 23 months. Our overall initial rate of closure was 94% with 100% after a second procedure.


CONCLUSIONS
Endoscopic repair of anterior skull base CSF fistulas has a high success rate and lower morbidity and mortality when compared with open approaches.
Alameda
Yadiel A
YA
Department of Otolaryngology-Head and Neck Surgery, University of Puerto Rico, San Juan, Puerto Rico 00936-5067. yaye7@yahoo.com
Busquets
José M
JM
Portela
Juan C
JC
D000293:Adolescent; D000328:Adult; D000368:Aged; D002559:Cerebrospinal Fluid Rhinorrhea / Q000175:diagnosis / Q000209:etiology / Q000601:surgery*; D004652:Empty Sella Syndrome / Q000209:etiology; D004677:Encephalocele / Q000150:complications; D004724:Endoscopy; D005004:Ethmoid Bone / Q000473:pathology / Q000601:surgery; D005005:Ethmoid Sinus / Q000473:pathology / Q000601:surgery; D005260:Female; D006261:Headache / Q000209:etiology; D006801:Humans; D008297:Male; D008581:Meningitis / Q000209:etiology; D008588:Meningocele / Q000150:complications; D008875:Middle Aged; D013517:Otorhinolaryngologic Surgical Procedures; D011183:Postoperative Complications / Q000209:etiology; D019291:Skull Base / Q000473:pathology / Q000601:surgery*; D013101:Sphenoid Sinus / Q000473:pathology / Q000601:surgery; D014182:Transplantation, Autologous; D016896:Treatment Outcome