title: Case-specific protocol to reduce cerebrospinal fluid leakage after endonasal endoscopic surgery.
abstract: OBJECTIVE
  Endoscopic transsphenoidal surgery is expanding in acceptance, yet postoperative CSF leak rates remain a concern. This study presents the Cornell closure protocol, which has yielded significantly lower postoperative CSF leak rates compared with prior reports, as an algorithm that can be used by centers having difficulty with CSF leak.
  
  
  METHODS
  A single closure algorithm for endoscopic surgery has been used since January 2010 at Weill Cornell Medical College. A prospective database noting intraoperative CSF leak, closure technique, and postoperative CSF leak was reviewed. The authors used a MEDLINE search to identify similar studies and compared CSF leak rates to those of patients treated using the Cornell algorithm.
  
  
  RESULTS
  The retrospective study of a prospectively acquired database included 209 consecutive patients. In 84 patients (40%) there was no intraoperative CSF leak and no postoperative CSF leak. In the 125 patients (60%) with an intraoperative CSF leak, 35 of them with high-flow leaks, there were 0 (0%) postoperative CSF leaks.
  
  
  CONCLUSIONS
  It is possible to achieve a CSF leak rate of 0% by using this closure protocol. With proper experience, endoscopic skull base surgery should not be considered to have a higher CSF leak rate than open transcranial or microscopic transsphenoidal surgery.
authors.affiliation: Departments of Neurosurgery, Weill Cornell Medical College, NewYork-Presbyterian Hospital, New York, New York 10065, USA.
authors.forename: Kunal S
authors.initials: KS
authors.lastname: Patel
authors.forename: Ricardo J
authors.initials: RJ
authors.lastname: Komotar
authors.forename: Oszkar
authors.initials: O
authors.lastname: Szentirmai
authors.forename: Nelson
authors.initials: N
authors.lastname: Moussazadeh
authors.forename: Daniel M
authors.initials: DM
authors.lastname: Raper
authors.forename: Robert M
authors.initials: RM
authors.lastname: Starke
authors.forename: Vijay K
authors.initials: VK
authors.lastname: Anand
authors.forename: Theodore H
authors.initials: TH
authors.lastname: Schwartz
mesh_terms: D000328:Adult; D000368:Aged; D002559:Cerebrospinal Fluid Rhinorrhea / Q000453:epidemiology / Q000209:etiology*; D002985:Clinical Protocols; D004724:Endoscopy / Q000009:adverse effects*; D005260:Female; D006801:Humans; D007431:Intraoperative Complications / Q000453:epidemiology*; D008297:Male; D008875:Middle Aged; D059747:Nasal Surgical Procedures / Q000009:adverse effects*; D057605:Natural Orifice Endoscopic Surgery / Q000009:adverse effects*; D011183:Postoperative Complications / Q000453:epidemiology / Q000209:etiology*; D011446:Prospective Studies; D012189:Retrospective Studies