Management of post-traumatic cerebrospinal fluid (CSF) leak of anterior skull base: 10 years experience.

CONCLUSION

Anterior skull base cerebrospinal fluid (CSF) leak should be surgically repaired with an endonasal approach first for less morbidity. Pretherapeutic topographical diagnosis increases the success rate of surgical repair.

OBJECTIVES

We aimed to evaluate our efficiency in taking care of post-traumatic anterior skull base CSF leak, since no consensual algorithms for diagnosis and treatment have been established.

METHODS

Data from 40 patients treated for post-traumatic CSF leak of the anterior skull base between January 1997 and December 2008 were retrospectively reviewed. Twenty-nine patients were treated with surgery, with an endonasal approach in 14 patients and a neurosurgical approach in 15 patients. A wait and see policy was applied in 11 patients.

RESULTS

The overall risk of reccurence was 22.5%. Recurrence was represented by the presence of CSF rhinorrhea in 12.5% and the appearance of meningitis in 10% of patients. The overall risk of postoperative anosmia was 27.5%. A wait and see policy led to a higher risk of developing meningitis than surgical repair (p = 0.0003). The absence of pretherapeutic topographical diagnosis led to a higher risk of recurrence of CSF rhinorrhea (p = 0.01). The endonasal approach resulted in less postoperative anosmia (p = 0.006).