• anterior cerebrospinal fluid leaks
• anterior skull base defect
• double flap technique
• endoscopic reconstruction
• graft
• ileotibial graft
• inferior turbinate flap
• medial turbinate flap
• multilayer reconstruction
• nasoseptal flap
• reconstructive technique
• sinonasal malignancies

Objectives/Hypothesis:
Endoscopic endonasal surgery is a validated technique in the repair of anterior skull base CSF leaks. Surgical repair is recommended for patients with CSF leaks that do not respond to conservative measures and iatrogenic defects that are discovered intraoperatively. A growing number of techniques have been adopted to date. Compared with the use of free-tissue grafts, there is increasing popularity of the vascularized pedicled flaps in endoscopic skull base surgery for the successful reconstruction of anterior skull base defects. Although the nasoseptal flap (NSF) continues to be the mainstay of endoscopic skull base reconstruction, alternative vascularized flaps exist when the NSF is impractical or unavailable, and new surgical approaches continue to evolve. The location and size of the defect are important considerations for selection of the most appropriate reconstructive approach.

The purpose of our study was to ascertain the outcome after transnasal endoscopic repair of CSF leaks and to identify factors regarding the patient, CSF fistula, and treatment that may influence the results of the repair.

Methods: We performed a meta-analysis of all studies published in English from 2007 onwards that reported a minimum of 10 cases with CSF fistulae that were repaired using an endoscopic approach. We analyzed data that included type of graft and technique used during the repair, surgical complications, the use of packing and the use of lumbar drains. The success rate was monitored and correlated with the other variables.

Results: 28 studies comprising 1767 CSF fistulae met the inclusion criteria. Endoscopic repair of CSF leaks was successful in 96 % of the cases after at first attempt.

The success rate of repairs using any of the reported techniques and materials was high and not statistically different.

The incidence of major complications such a meningitis, subdural hematoma, and intracranial abscess was less than 1% for each complication.

Conclusion: The endoscopic approach is highly effective and is associated with low morbidity. The literature supports the endoscopic approach using a variety of techniques and materials for the repair of CSF leaks.