The surgical treatment of cerebrospinal fistula: Qualitative and quantitative analysis of indications and results
Alessandra Iavarone MD
Unit of Otorhinolaryngology Head and Neck Surgery, Department of Surgery and Translational Medicine, University of Florence, Florence, Italy
Search for more papers by this authorPaolo Luparello MD
Unit of Otorhinolaryngology Head and Neck Surgery, Department of Surgery and Translational Medicine, University of Florence, Florence, Italy
Search for more papers by this authorMaria Silvia Lazio MD
Unit of Otorhinolaryngology Head and Neck Surgery, Department of Surgery and Translational Medicine, University of Florence, Florence, Italy
Search for more papers by this authorLara Valentina Comini MD
Unit of Otorhinolaryngology Head and Neck Surgery, Department of Surgery and Translational Medicine, University of Florence, Florence, Italy
Search for more papers by this authorFederica Martelli MD
Unit of Otorhinolaryngology Head and Neck Surgery, Department of Surgery and Translational Medicine, University of Florence, Florence, Italy
Search for more papers by this authorOliviero De Luca MD
Head and Neck and Robotic Surgery, Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
Search for more papers by this authorGiovanni Paolo Santoro MD
Head and Neck and Robotic Surgery, Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
Search for more papers by this authorRoberto Santoro MD
Head and Neck and Robotic Surgery, Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
Search for more papers by this authorGiammarco Alderotti PhD
Department of Statistics Science, University “La Sapienza” of Rome, Rome, Italy
Search for more papers by this authorCorresponding Author
Giuditta Mannelli MD
Head and Neck and Robotic Surgery, Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
Correspondence
Giuditta Mannelli, Head and Neck and Robotic Surgery, Department of Experimental and Clinical Medicine, University of Florence, Florence 50141, Italy.
Email: [email protected]
Search for more papers by this authorAlessandra Iavarone MD
Unit of Otorhinolaryngology Head and Neck Surgery, Department of Surgery and Translational Medicine, University of Florence, Florence, Italy
Search for more papers by this authorPaolo Luparello MD
Unit of Otorhinolaryngology Head and Neck Surgery, Department of Surgery and Translational Medicine, University of Florence, Florence, Italy
Search for more papers by this authorMaria Silvia Lazio MD
Unit of Otorhinolaryngology Head and Neck Surgery, Department of Surgery and Translational Medicine, University of Florence, Florence, Italy
Search for more papers by this authorLara Valentina Comini MD
Unit of Otorhinolaryngology Head and Neck Surgery, Department of Surgery and Translational Medicine, University of Florence, Florence, Italy
Search for more papers by this authorFederica Martelli MD
Unit of Otorhinolaryngology Head and Neck Surgery, Department of Surgery and Translational Medicine, University of Florence, Florence, Italy
Search for more papers by this authorOliviero De Luca MD
Head and Neck and Robotic Surgery, Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
Search for more papers by this authorGiovanni Paolo Santoro MD
Head and Neck and Robotic Surgery, Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
Search for more papers by this authorRoberto Santoro MD
Head and Neck and Robotic Surgery, Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
Search for more papers by this authorGiammarco Alderotti PhD
Department of Statistics Science, University “La Sapienza” of Rome, Rome, Italy
Search for more papers by this authorCorresponding Author
Giuditta Mannelli MD
Head and Neck and Robotic Surgery, Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
Correspondence
Giuditta Mannelli, Head and Neck and Robotic Surgery, Department of Experimental and Clinical Medicine, University of Florence, Florence 50141, Italy.
Email: [email protected]
Search for more papers by this authorAbstract
Cerebrospinal fistula might occur in different ways. CSF closure techniques have undergone significant evolution that has led to the consolidation of the transnasal endoscopic approach. Despite the existence of multiple publications, meaningful information is still lacking in clinical practice and the literature about the ideal method, material, and timing for repair of CSF. The purpose of this review was to summarize the success rate of endoscopic CSF leak repair as well as whether specific techniques or materials influence the primary success rate through a review of the latest advancements in endoscopic CSF management published in the past 10 years. The principles of multilayer reconstructions and the routine use of vascularized flaps in expanded endonasal surgery have reduced postoperative CSF leaks' failure rates between 5% and 10% (4% in this meta-analysis). Effective endoscopic anterior skull base (ASB) closure may be achieved by multiple reconstructive techniques, which should be tailored case by case according to the patient and defect conditions.
CONFLICT OF INTEREST
The authors declare no potential conflict of interest.
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