title: Endoscopic repair of cerebrospinal fluid rhinorrhoea.
abstract: OBJECTIVE
  The purpose of this review was to look at the success rate of transnasal endoscopic repair of CSF rhinorrhoea and the impact of patient factors, repair techniques and adjuvant treatment.
  
  
  METHODS
  A literature search was performed on PubMed, Medline and Cochrane Central databases, independently by two of the authors, of all studies reporting the outcomes of CSF rhinorrhoea repair, published until the 1st June 2014, using keywords Cerebrospinal fluid leak, CSF leak, CSF fistula, CSF leak or fistula repair, endoscopic sinus surgery or ESS complications. Sixty-seven papers were included for the review.
  
  
  RESULTS
  The repair of CSF rhinorrhoea has rapidly evolved over the past 30 years. Prior to the advent of the endoscopic approach, craniotomy was used for repairs, which carried a variable success rate and morbidity. More recently, there have been several case series and reports that describe various endoscopic methods and materials for repair, with mean success rate of 90% (range: 60-100%). The most common site of CSF leak is the ethmoid roof/cribriform plate region. Traumatic CSF leak, in particular iatrogenic, is still the most common cause. Imaging with CT and MRI remains the gold standard for localisation of CSF leaks. The sphenoid sinus is the most common location for CSF leak repair failure. Lumbar drains and antibiotics are used as adjuvant therapy to endoscopic repair, but their benefits are not clear; intrathecal fluorescein can be used to aid location of CSF leak, but should be reserved for more complex cases. Further work into graft materials used and adjuvant treatment is needed to make any meaningful conclusions about their efficacy.
  
  
  CONCLUSIONS
  The literature demonstrates that endoscopic repair of CSF rhinorrhoea is safe and effective, with a very low complication rate. It has almost completely replaced the older open techniques.
authors.affiliation: Department of Otorhinolaryngology, Queens Hospital, Rom Valley Way, Romford, RM7 0AG Essex, United Kingdom. Electronic address: sunilsharma@doctors.org.uk.
authors.forename: S D
authors.initials: SD
authors.lastname: Sharma
authors.affiliation: Department of Otorhinolaryngology, Queens Hospital, Rom Valley Way, Romford, RM7 0AG Essex, United Kingdom. Electronic address: drgauravkr@gmail.com.
authors.forename: G
authors.initials: G
authors.lastname: Kumar
authors.affiliation: Department of Otorhinolaryngology, Queens Hospital, Rom Valley Way, Romford, RM7 0AG Essex, United Kingdom. Electronic address: jarnail.bal@bhrhospitals.nhs.uk.
authors.forename: J
authors.initials: J
authors.lastname: Bal
authors.affiliation: Department of Otorhinolaryngology, Queens Hospital, Rom Valley Way, Romford, RM7 0AG Essex, United Kingdom. Electronic address: azews@yahoo.com.
authors.forename: A
authors.initials: A
authors.lastname: Eweiss
mesh_terms: D002559:Cerebrospinal Fluid Rhinorrhea / Q000601:surgery*; D004322:Drainage; D004724:Endoscopy / Q000379:methods*; D005005:Ethmoid Sinus / Q000601:surgery; D006801:Humans; D013101:Sphenoid Sinus / Q000601:surgery
keywords: Cerebrospinal fluid fistula; Cerebrospinal fluid leak; Cerebrospinal fluid leak repair; Endoscopic repair of cerebrospinal fluid leak; Endoscopic sinus surgery