Endoscopic management of spontaneous clival CSF leaks: case series and literature review.

Endoscopic management of spontaneous clival CSF leaks: case series and literature review.

World Neurosurg. 2015 Nov 25;

Authors: Pagella F, Pusateri A, Matti E, Zoia C, Benazzo M, Gaetani P, Cazzador D, Volo T, Borsetto D, Emanuelli E

Abstract
OBJECTIVE: Spontaneous cerebrospinal fluid leaks are most commonly located along the anterior skull base. Sphenoidal localization is less common and, among these, clival localization is even rarer. We analyzed a group of patients with spontaneous leaks and selected patients with clival localization. Surgical management of these entities will be discussed and a brief literature review regarding spontaneous clival leaks will be reported in this paper.
METHODS: Of a cohort of 67 patients who presented to our departments with a spontaneous leak between 2005 and 2014, retrospective data analysis was performed on six patients with clival localization of the defect. Three patients received a skull base repair with a multilayered reconstruction, and three patients underwent a single-layered reconstruction using a pedicled nasoseptal flap.
RESULTS: The patient cohort included six women with a mean age of 60 (36-91 years old). The mean length of the follow-up was 69.5 months (22-114 months). The overall success rate of the primary endoscopic repair was 83.3% (five out of six), this increased to 100% after revision surgery.
CONCLUSIONS: This series, though 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, nowadays the pedicled nasoseptal flap has been confirmed to be the "workhorse" for the reconstruction of clival defects.

PMID: 26626813 [PubMed - as supplied by publisher]

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