ABSTRACT
Cerebrospinal fluid (CSF) leaks result from a communication between the subarachnoid
space and the upper aerodigestive tract. Because of the risk of complications such
as meningitis, brain abscess, and pneumocephalus, all persistent CSF leaks should
be repaired. Surgical repair may be achieved transcranially or extracranially using
a wide variety of autogenous, allogenic, and synthetic patching materials. We report
our results with a transnasal transsphenoidal endoscopic approach for the repair of
CSF leaks coupled with a multilayer closure using acellular dermis (Alloderm™). We
conducted a retrospective review of all patients presenting to our institution over
the past 5 years with isolated sphenoid sinus CSF fistulas. Results: Twenty-one patients
were included in the study. Nineteen patients (90.5%) had their sphenoid sinus CSF
fistula repaired during the first attempt; 2 patients (9.5%) needed a second attempt.
The multilayer repair of the CSF leak using acellular dermis via a transsphenoidal
endoscopic approach is an effective and successful method of surgical repair of the
fistula site. Neither the number, size, nor cause of the CSF fistula affected surgical
outcomes. However, the presence of hydrocephalus was a significant negative variable,
altering the surgical outcomes of our patients. The acellular dermis offers the advantage
of not requiring autogenous tissue for the effective repair of CSF leaks in the sphenoid
sinus.
KEYWORDS
Transnasal approach - multilayer repair - sphenoid sinus - CSF leak
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Ahmed Soliman IsmailM.D. Ph.D.
The Center for Cranial Base Surgery, St. Luke's Roosevelt Medical Center
1000 Tenth Ave., Ste. 5G-80, New York, NY, 10019
Email: ahmedsoliman3@hotmail.com
