DETERMINANTS OF SUCCESS IN ENDOSCOPIC CEREBROSPINAL FLUID LEAK REPAIR

Additional factors that could impact successful leak repair include a host of other local wound characteristics and patient comorbidities. Factors with potential negative impact on wound healing such as defect size, use of perioperative or chronic steroids, diabetes mellitus, prior or subsequent radiation exposure, and presence of residual tumor at the leak site.The observation that patients with spontaneous CSF rhinorrhea tend to be obese females also raises the question of whether obesity presents an additional obstacle to successful CSF leak repair irrespective of the etiology of the leak. Morbid obesity has been noted previously as a risk factor for spontaneous CSF rhinorrhea.The potential for larger transient ICP elevations in obese individuals may be the central factor placing them at greater risk for not only the development of spontaneous CSF leaks but also the failure of repairs for spontaneous or iatrogenic leaks. Transient elevations in ICP have been theorized to contribute to the evolution of meningoceles that become spontaneous leak sites via hydrostatic pressure exerted against pre-existing skull base defects. A common mechanism involving ICP elevation has also been suggested to underlie a clinical association between empty sella syndrome and spontaneous CSF leak. At the simplest level, obesity may elevate ICP by causing larger rises in intra-abdominal and intrathoracic pressure with straining or valsalva, resulting in transmission of elevated venous pressures to the subarachnoid space.Aim of the workThe aim of the work is to define and find the factors which increase incidence of success of endoscopic surgery to cure the cerebrospinal fluid rhinorrhea.