title: Surgical challenge: endoscopic repair of cerebrospinal fluid leak.
abstract: BACKGROUND
  Cerebrospinal fluid leaks (CSF) result from an abnormal communication between the subarachnoid space and the extracranial space. Approximately 90% of CSF leak at the anterior skull base manifests as rhinorrhea and can become life-threatening condition. Endoscopic sinus surgery (ESS) has become a common otolaryngologist procedure. The aim of this article is to consider our experience and to evaluate the outcomes in patients who underwent a purely endoscopic repair of CSF leaks of the anterior skull base.
  
  
  RESULTS
  Retrospective chart review was performed of all patients surgically treated for CSF leaks presenting to the Section of Nasal and Sinus Disorders at the Service of ENT-Head and Neck Surgery, University Hospital Complex of Santiago de Compostela (CHUS), between 2004 and 2010. A total of 30 patients who underwent repair CSF leak by ESS. The success rate was 93.4% at the first attempt; only two patients (6.6%) required a second surgical procedure, and none of it was necessary to use a craniotomy for closure. Follow-up periods ranged from 4 months to 6 years.
  
  
  CONCLUSIONS
  Identifying the size, site, and etiology of the CSF leak remains the most important factor in the surgical success. It is generally accepted that the ESS have made procedures minimally invasive, and CSF leak is now one of its well-established indications with low morbidity and high success rate, with one restriction for fistulas of the posterior wall of the frontal sinus should be repaired in conjunction with open techniques.
authors.affiliation: Servizo Galego de Saúde, Service of ENT–Head and Neck Surgery, University Hospital Complex of Santiago de Compostela (CHUS), Santiago de Compostela, Spain.
authors.forename: Carlos
authors.initials: C
authors.lastname: Martín-Martín
authors.forename: Gabriel
authors.initials: G
authors.lastname: Martínez-Capoccioni
authors.forename: Ramón
authors.initials: R
authors.lastname: Serramito-García
authors.forename: Federico
authors.initials: F
authors.lastname: Espinosa-Restrepo
mesh_terms: D000328:Adult; D065634:Cerebrospinal Fluid Leak; D002559:Cerebrospinal Fluid Rhinorrhea / Q000000981:diagnostic imaging / Q000209:etiology / Q000601:surgery*; D003392:Cranial Sinuses / Q000000981:diagnostic imaging / Q000601:surgery*; D004724:Endoscopy / Q000009:adverse effects; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D019635:Neurosurgical Procedures / Q000009:adverse effects; D011237:Predictive Value of Tests; D012086:Reoperation; D012189:Retrospective Studies; D013030:Spain; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome