The endoscopic endonasal approach for cerebrospinal fluid leak repair in the elderly.
BACKGROUND
Cerebrospinal fluid (CSF) rhinorrhea can lead to CNS infections, carrying significant morbidity and mortality, especially in the elderly. Endoscopic endonasal surgery is a validated technique in the repair of anterior skull base CSF leaks. The aim of this study is to assess diagnostic management, surgical technique and clinical outcome in a consecutive series of elderly patients.


METHODS
Patients older than 65 years treated for anterior skull base CSF leaks through endoscopic endonasal surgery between 2003 and 2014 were retrospectively reviewed. All patients underwent preoperative nasal endoscopy, laboratory and radiological assessment. In doubtful cases endoscopic exploration was performed after intrathecal fluorescein (IF) injection. Patients were discharged between 3 and 4 days after surgery, and the endoscopic follow-up ranged from 3 to 24 months.


RESULTS
20 patients (age range 65-92) presented with 10 spontaneous and 10 traumatic/iatrogenic CSF leaks. In 40% of patients formal rhinoscopy and radiological assessment did not localize the CSF leak and IF injection was performed. IF enabled the identification of the skull base defect in all cases, with no adverse effects. In 11 cases the dura was repaired with fascia lata graft. All patients had successful endoscopic repair of the CSF fistula with no complications nor recurrences during follow-up.


CONCLUSIONS
Endoscopic endonasal surgery is a minimally invasive procedure for CSF leak treatment. In our experience, IF injection proved safe and efficient in detecting skull base defects not identified by preoperative imaging. Endoscopic endonasal surgery proved effective and reliable also in elderly patients, with short hospitalization times and no morbidity.
Operative Unit of Otolaryngology and Otosurgery, Department of Neuroscience, University of Padua, Via Giustiniani, 2, 35128 Padua, Italy.
Enzo
E
Emanuelli
Department of Neuroscience, University of Padua, via Giustiniani, 5, 35128 Padua, Italy. Electronic address: laura_ny10@yahoo.com.
Laura
L
Milanese
Department of Neuroscience, University of Padua, via Giustiniani, 5, 35128 Padua, Italy.
Marta
M
Rossetto
Operative Unit of Otolaryngology and Otosurgery, Department of Neuroscience, University of Padua, Via Giustiniani, 2, 35128 Padua, Italy.
Diego
D
Cazzador
Department of Neuroscience, University of Padua, via Giustiniani, 5, 35128 Padua, Italy.
Elena
E
d'Avella
Operative Unit of Otolaryngology and Otosurgery, Department of Neuroscience, University of Padua, Via Giustiniani, 2, 35128 Padua, Italy.
Tiziana
T
Volo
Department of Neuroscience, University of Padua, via Giustiniani, 5, 35128 Padua, Italy.
Valentina
V
Baro
Department of Neuroscience, University of Padua, via Giustiniani, 5, 35128 Padua, Italy.
Luca
L
Denaro
Department of Neuroscience, University of Padua, via Giustiniani, 5, 35128 Padua, Italy.
Giorgio
G
Gioffrè
Operative Unit of Otolaryngology and Otosurgery, Department of Neuroscience, University of Padua, Via Giustiniani, 2, 35128 Padua, Italy.
Daniele
D
Borsetto
Operative Unit of Otolaryngology and Otosurgery, Department of Neuroscience, University of Padua, Via Giustiniani, 2, 35128 Padua, Italy.
Alessandro
A
Martini
D000368:Aged; D000369:Aged, 80 and over; D065634:Cerebrospinal Fluid Leak / Q000601:surgery*; D002559:Cerebrospinal Fluid Rhinorrhea / Q000601:surgery; D004724:Endoscopy / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006261:Headache / Q000209:etiology; D006801:Humans; D008297:Male; D009296:Nasal Cavity / Q000601:surgery*; D019635:Neurosurgical Procedures / Q000379:methods*; D011300:Preoperative Care; D012189:Retrospective Studies; D019291:Skull Base / Q000601:surgery; D016896:Treatment Outcome
Cerebrospinal fluid leak; Elderly; Endoscopic endonasal approach; Endoscopic endonasal surgery; Fascia lata