[Management of cerebrospinal fluid leaks according to size. Our experience].
OBJECTIVE
We present our experience in the reconstruction of cerebrospinal fluid (CSF) leaks according to their size and location.


METHODS
Fifty-four patients who underwent advanced skull base surgery (large defects) and 62 patients with CSF leaks of different origin (small and medium-sized defects) were included. Large defects were reconstructed with a nasoseptal pedicled flap positioned on fat and fascia lata and lumbar drainage was used. In small and medium-sized leaks of other origin, intrathecal fluorescein 5% was applied previously to identify the defect. Fascia lata in an underlay position was used for reconstruction, which was then covered with mucoperiosteum from the turbinate. Perioperative antibiotics were administered for 5-7 days. Nasal packing was removed after 24-48 hours.


RESULTS
The most frequent aetiology for small and medium-sized defects was spontaneous (48.4%), followed by trauma (24.2%), iatrogenic (5%) and others. The success rate was of 91% after the first surgery and 98% in large skull base defects and small/medium-sized respectively. After rescue surgery, the rate of closure achieved was 100%. The follow-up was 15.6 ± 12.4 months for large defects and 75.3 ± 51.3 months for small/medium-sized defects without recurrence.


CONCLUSIONS
Endoscopic surgery for closure of any type of skull base defect is the gold standard approach. Defect size does not play a significant role in the success rate. Fascia lata and mucoperiosteum allow a reconstruction of small/medium-sized defects. For larger skull base defects, a combination of fat, fascia lata and nasoseptal pedicled flaps provide a successful reconstruction.
Unidad de Base de Cráneo, Servicio de Otorrinolaringología, Hospital Clínic, Barcelona, España. Electronic address: isamobid@hotmail.com.
Isam
I
Alobid
Unidad de Base de Cráneo, Servicio de Neurocirugía, Hospital Clínic, Barcelona, España.
Joaquim
J
Enseñat
Unidad de Base de Cráneo, Servicio de Otorrinolaringología, Althaia Xarxa Assistencial, Manresa, Barcelona, España.
Elena
E
Rioja
Unidad de Base de Cráneo, Servicio de Otorrinolaringología, Hospital Clínic, Barcelona, España.
Karla
K
Enriquez
Unidad de Base de Cráneo, Servicio de Otorrinolaringología, Hospital Clínic, Barcelona, España.
Liza
L
Viscovich
Unidad de Base de Cráneo, Servicio de Neurocirugía, Hospital Clínic, Barcelona, España.
Matteo
M
de Notaris
Unidad de Base de Cráneo, Servicio de Otorrinolaringología, Hospital Clínic, Barcelona, España.
Manuel
M
Bernal-Sprekelsen
D000465:Algorithms; D002559:Cerebrospinal Fluid Rhinorrhea / Q000175:diagnosis* / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D013517:Otorhinolaryngologic Surgical Procedures / Q000379:methods
Base de cráneo; Cerebrospinal fluid-leaks; Cirugía endoscópica nasosinusal; Endoscopic sinus surgery; Fascia lata; Fluorescein; Fluoresceína; Fístulas de líquido cefalorraquídeo; Licuorrea; Meningitis; Paranasal sinuses; Senos paranasales; Skull base