Endoscopic Endonasal Management of Petroclival Cerebrospinal Fluid Leaks: Anatomical Study and Preliminary Clinical Experience

Abstract

Background: Endonasal management of most anterior cranial fossa cerebrospinal fluid leaks is a well established procedure, and even some middle cranial fossa cerebrospinal fluid leaks can be managed safely endonasally. Endonasal endoscopic management of leakages of the posterior cranial fossa represents an unique challenge.

Objective: The aim of this study was to assess the feasibility of an endoscopic endonasal approach for treating well-selected cerebrospinal fluid leaks of the petroclival region.

Methods: Clinical charts of patients with leakages of the petroclival region treated at our institution were retrospectively reviewed. Careful dissection of the petroclival region was performed, both endonasally and externally, in three fresh injected heads.

Results: Two patients presented a leakage of the petroclival region. Both the patients presented multiple skull base defects. The two patients underwent a supratubaric trans-spheno-petroclival approach; in one of these, it was performed in combination with a middle cranial fossa approach. Multilayer reconstruction was performed in both patients. No cerebrospinal fluid leak recurrences were observed during follow-up (17 and 19 months, respectively).

Conclusions: Endonasal endoscopic management of well-selected petroclival cerebrospinal fluid leaks is feasible.

cerebrospinal fluid leak - petroclival - endoscopic - multilayer plasty

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