Long-Term Outcomes of Endonasal Endoscopic Cerebrospinal Fluid Leak Repairs: A Pooled Data Analysis Using Kaplan-Meier Techniques

Introduction: The successes of endonasal endoscopic repairs of sinonasal cerebrospinal fluid leaks have typically been published using a percentage of cases without respect to the varying periods of follow-up. This study aims to provide an assessment of the success rate over time based on validated statistical methods.

Methods: A search was conducted of MEDLINE (1966 to 2011), EMBASE (1980 to 2011), Cochrane Central Register of Clinical Trials (CENTRAL), Cochrane Database of Systematic Reviews, clinicaltrials.gov, and The National Guideline Clearinghouse databases, and it was supplemented by references in retrieved articles. All authors used a detailed list of inclusion and exclusion criteria to determine articles eligible for final inclusion. The authors extracted data regarding study criteria appraisal, CSF leak and surgical characteristics, recurrence outcomes, and complications. Kaplan-Meier locoregional control (LRC) rates were calculated.

Results: The search results captured 2,181 citations. Thirty-one studies and 303 subjects were included in the pooled analysis. The most common locations of CSF leak included ethmoid sinus, cribriform plate, and sphenoid sinus. The overall 3-year LRC rate for the analyzable sample was 93.5% (SE ± 2.1) with a mean follow-up of 30.3 months (SE ± 1.9). Two thirds (66.7%) of recurrences occurred within a month after surgery; however, other recurrences occurred more than a month after the surgery and as late as 15 months postoperatively. Sphenoid sinus location (89.6%, OR = 0.52, 95% CI 0.30-0.91, P = 0.02) and spontaneous etiology (90.1%, OR = 0.67, 95% CI 0.42-1.07, P = 0.09) were associated with lower locoregional control. Iatrogenic etiology was associated with late recurrences. There was no difference in outcomes based on lumbar drain (LD) use or type of grafting material.

Conclusions: Endonasal endoscopic CSF leak repair is a highly successful technique. In this analysis, sphenoid sinus location and spontaneous etiology were associated with lower success. Iatrogenic etiology was associated with delayed recurrence.