Objectives/Hypothesis: Trauma and surgery are the most common causes of cerebrospinal fluid (CSF) rhinorrhea. Surgical repair is recommended for patients with CSF leaks that do not respond to conservative measures, traumatic CSF leaks that require transcraniaJ surgery for associated brain injuries, and iatrogenic defects that are discovered intraoperatively. The purpose of our study was to ascertain the outcome after transnasa] endoscopic repair of CSF leaks and to identify factors regarding the patient, CSF fistuJa, and treatment that may influence the resuJts of the repair. Methods: We performed a metaanalysis of all studies published in English between 1990 and 1999 that reported a minimum of five patients with CSF fi stuJae that were repaired using an e ndoscopic approach. We analyzed data that included type of graft and technique u sed during the repair, surgical complications, the use of packing, and the u se of lumbar drains and antibiotics. The success rate was monitored and correlated with the other variables. The me ta-analysis database was compared with and a dded to a database comprising our own patients. Results: Fourteen studies comprising 289 CSF fistulae m et the inclusion criteria. Endoscopic repair of CSF leaks was successful in 90% (259/289) of the cases after a fir t attempt. Seventeen of 30 persistent leaks (52%) were cJosed after a second attempt. Thus ultimately 97% (2761289) of the leaks were repaired u sing an endoscopic approach. The success rate of repairs u sing any of the reported techniques and mate rials was high and not statistically different. The incidence of major complications such a meningitis, subdural h ematoma, and intracranial abscess was less than 1% for each complication. Conclusion: The endoscopic approach is highly effective and is associated with Jow morbidity. The literature supports the e ndoFrom the D pa rtmenta of Otolaryngology (1u1.11 ., R.L.c., c.J.s., J.z.) a nd Neurologica l Surgery (A.K.) and the Crani al Base Center, University of Pittsburgh Medical enter, Pittsburgh, P nnsylvan ia.

If the surgical technique is sound, endoscopic repair of CSF leaks is highly successful, independent of the choice of the material and technique used in the repair.

Meningoceles, encephaloceles, and meningo-encephaloceles may develop through defects associated with congenital anomalies or through defects produced by tumor, trauma, or surgery. Their initial management, surgical indications, and repair techniques are not universally accepted. We undertook this study to compare the contributions of different surgical techniques and materials to the success of endoscopic repairs of acquired meningo-encephaloceles. We also examined whether characteristics of the patient, the meningo-encephalocele, or the adjunctive treatment influenced the outcome of the repair.We retrospectively reviewed the clinical charts of all patients undergoing transnasal endoscopic repair of acquired meningo-encephaloceles at our academic hospitals. We encountered 17 patients with meningo-encephaloceles of the anterior fossa and parasellar area; 15 were repaired immediately using transnasal endoscopic techniques. Two persistent leaks associated with hydrocephalus were repaired during a second endoscopic attempt, which was rapidly followed by ventriculoperitoneal shunting. Location and size of the skull base defect, its etiology, and the technique and choice of material used for repair did not significantly affect surgical outcomes. However, the presence of hydrocephalus was significantly related to poor surgical outcomes.