title: Endoscopic Management of Spontaneous Clival Cerebrospinal Fluid Leaks: Case Series and Literature Review.
abstract: OBJECTIVE
  Spontaneous cerebrospinal fluid leaks are most commonly located along the anterior skull base. Sphenoidal localization is less common, and clival localization is even rarer. We analyzed a group of patients with spontaneous leaks and selected patients with clival localization. This article discusses surgical management of these entities and provides a brief literature review regarding spontaneous clival leaks.
  
  
  METHODS
  Of a cohort of 67 patients who presented to our departments with a spontaneous leak during the period 2005-2014, a retrospective data analysis was performed on 6 patients with clival localization of the defect. A skull base repair with a multilayered reconstruction was performed in 3 patients, and a single-layered reconstruction using a pedicled nasoseptal flap was performed in 3 patients.
  
  
  RESULTS
  The patients included 6 women with a mean age of 60 years (range, 36-91 years). The mean length of the follow-up period was 69.5 months (range, 22-114 months). The overall success rate of the primary endoscopic repair was 83.3% (5 of 6 patients); this increased to 100% after revision surgery.
  
  
  CONCLUSIONS
  This series, although numerically limited, suggests that a minimally invasive endoscopic repair of idiopathic clival leaks may be accomplished with an acceptable rate of morbidity and excellent outcomes. Moreover, the pedicled nasoseptal flap has been confirmed to be the "workhorse" for the reconstruction of clival defects.
authors.affiliation: Department of Otorhinolaryngology, Fondazione I.R.C.C.S. Policlinico San Matteo, University of Pavia, Pavia, Italy.
authors.forename: Fabio
authors.initials: F
authors.lastname: Pagella
authors.affiliation: Department of Otorhinolaryngology, Fondazione I.R.C.C.S. Policlinico San Matteo, University of Pavia, Pavia, Italy. Electronic address: ale.pusateri@gmail.com.
authors.forename: Alessandro
authors.initials: A
authors.lastname: Pusateri
authors.affiliation: Department of Otorhinolaryngology, Fondazione I.R.C.C.S. Policlinico San Matteo, University of Pavia, Pavia, Italy.
authors.forename: Elina
authors.initials: E
authors.lastname: Matti
authors.affiliation: Department of Neurosurgery, Fondazione I.R.C.C.S. Policlinico San Matteo, University of Pavia, Pavia, Italy.
authors.forename: Cesare
authors.initials: C
authors.lastname: Zoia
authors.affiliation: Department of Otorhinolaryngology, Fondazione I.R.C.C.S. Policlinico San Matteo, University of Pavia, Pavia, Italy.
authors.forename: Marco
authors.initials: M
authors.lastname: Benazzo
authors.affiliation: Department of Neurosurgery, Fondazione I.R.C.C.S. Policlinico San Matteo, University of Pavia, Pavia, Italy.
authors.forename: Paolo
authors.initials: P
authors.lastname: Gaetani
authors.affiliation: Department of Otorhinolaryngology and Otologic Surgery, Azienda Ospedaliera-Policlinico of Padova, University of Padova, Padova, Italy.
authors.forename: Diego
authors.initials: D
authors.lastname: Cazzador
authors.affiliation: Department of Otorhinolaryngology and Otologic Surgery, Azienda Ospedaliera-Policlinico of Padova, University of Padova, Padova, Italy.
authors.forename: Tiziana
authors.initials: T
authors.lastname: Volo
authors.affiliation: Department of Otorhinolaryngology and Otologic Surgery, Azienda Ospedaliera-Policlinico of Padova, University of Padova, Padova, Italy.
authors.forename: Daniele
authors.initials: D
authors.lastname: Borsetto
authors.affiliation: Department of Otorhinolaryngology and Otologic Surgery, Azienda Ospedaliera-Policlinico of Padova, University of Padova, Padova, Italy.
authors.forename: Enzo
authors.initials: E
authors.lastname: Emanuelli
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D065634:Cerebrospinal Fluid Leak / Q000175:diagnosis / Q000209:etiology / Q000601:surgery*; D003388:Cranial Fossa, Posterior; D004724:Endoscopy / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged
keywords: CSF leaks; CSF rhinorrhea; Endoscopic skull base surgery; Skull base repair; Sphenoid sinus