Endoscopic repair of cerebrospinal fluid (CSF) fistulas is a minimally invasive surgical technique used to close defects of the dura mater through which cerebrospinal fluid leaks. This condition, known as CSF leak (liquorrhea), may develop as a result of trauma, previous surgical interventions, tumors, or congenital abnormalities.
Causes and indications for surgery
Causes of CSF leakage
- Traumatic brain injury (TBI).
- Previous neurosurgical or endoscopic sinus surgery.
- Tumors of the skull base.
- Infectious diseases (meningitis, encephalitis).
- Congenital skull base defects.
Indications for endoscopic repair:
- CSF leakage through the nasal cavity (CSF rhinorrhea).
- Persistent headaches that worsen with head elevation.
- Recurrent meningitis caused by ascending infection.
- Confirmed CSF leak with visualization of the defect on CT or MRI.
Preoperative preparation
Diagnostic investigations:
- Contrast-enhanced MRI.
- CT scan of the skull base.
- Cisternography.
- Beta-2 transferrin test.
Patient assessment:
- Blood tests (complete blood count, coagulation profile).
- Consultation with an otorhinolaryngologist (ENT specialist) and a neurosurgeon.
- Exclusion of active infectious processes.
Preoperative measures:
- Antibiotic prophylaxis to prevent infection.
- Patient education regarding the procedure and postoperative recovery.
Surgical procedure
- Anesthesia. The procedure is performed under general anesthesia.
- Access to the fistula. Endoscopic transnasal approach through the nasal passages, avoiding large external incisions.
- Identification of the defect. The fistula site is precisely localized using an endoscopic camera.
- Defect closure. Biological or synthetic materials are used, including autologous tissues (fascia, fat, cartilage) or alloplastic materials (collagen matrices, surgical adhesives).
- Watertightness control. Absence of further CSF leakage is verified intraoperatively.
- Completion of surgery. Temporary CSF drainage may be placed if required. The surgical area is stabilized and secured.
Postoperative recovery
- Early postoperative period. In-hospital observation for 1–3 days. Physical activity restriction, avoidance of heavy lifting, head bending, and sudden movements.
- Recommendations. Antibiotic therapy to prevent infection. Analgesics if required. Avoidance of nose blowing for 2–3 weeks.
- Follow-up imaging. Control CT or MRI to assess the integrity of the repair.
Advantages of endoscopic repair
- Minimally invasive approach. No large incisions and minimal tissue trauma.
- High precision. Endoscopic visualization provides excellent anatomical detail.
- Rapid recovery. Short rehabilitation period.
- Cosmetic benefit. No external scars.
Endoscopic repair of CSF fistulas in Belarus is an effective and safe treatment option that ensures reliable closure of dural defects with minimal surgical trauma. Timely diagnosis and expert surgical management allow full recovery and help prevent serious complications, including infections of the central nervous system.
