Endoscopic management of rhinobasal cerebrospinal fluid fistulae

Abstract

A dural fistula may present with cerebrospinal fluid (CSF) rhinorrhoea, a pneumoencephalocele or recurrent bacterial meningitis. A dural fistula carries a cumulative risk of meningitis of about 10% per year, even if a CSF leak has stopped. Anterior skull-base dural fistulae should be explored and closed, even if the leak ceases spontaneously. Intrathecal fluorescein is an excellent method for locating a dural defect, even if it is not actively leaking at the time of endoscopic exploration. Many dural fistulae can be located and closed by endoscopic surgical techniques. Frontal sinus leaks are not easily accessible endoscopically and present with their own unique problems. Meticulous technique rather than the type of graft is the key to success. © 2009 Springer Berlin Heidelberg.