Outcome Comparison of Endoscopic (Endonasal Trans-Sphenoidal) Repairs of CSS Leak vs. Transcranial Approach


  • Ishfaque Ahmed Simair AMC/Post Graduate Medical Institute (PGMI), Punjab Institute of Neurological Sciences (PINS), Department of Neurosurgery, Lahore General Hospital (LGH), Lahore, Pakistan
  • Jawad Ali AMC/Post Graduate Medical Institute (PGMI), Punjab Institute of Neurological Sciences
  • Abid Khattak AMC/Post Graduate Medical Institute (PGMI), Punjab Institute of Neurological Sciences
  • Amjad Qureshi Department of Neurosurgery, Agha Khan University Hospital, Karachi,
  • Tarique Salah-ud- Din AMC/Post Graduate Medical Institute (PGMI), Punjab Institute of Neurological Sciences




Cerebrospinal Fluid Leak, Rhinorrhea, Tran-sphenoidal, Endo nasal repair, Trans-cranial approach


Objective:   To compare the effectiveness of Endoscopic (Endonasal transsphenoidal) repair of CSF leak with transcranial approach in terms of post-operative complications like infection, recurrence and hospital stay.

Material and Methods:  The comparative experimental randomized study was conducted in the Department of Neurosurgery Unit I, PGMI, Lahore General Hospital, Lahore. After approval from ethical committee this study was carried out in our unit. 40 subjects with the history of CSF leak were randomly divided into two groups; one was treated with endonasal trans-sphenoidal repair and another was treated with trans-cranial approach, the subjects were followed up for 1 year. Detailed history, neurological examination, preoperative CT and MRI scans were performed in all patients.

Results:  The mean age of patients with CSF leak was 25.58 ± 14.38 years. Among the patients, 17 were females and 23 were male. The mean age of the female was 31.70 ± 14.29 years. The mean age of the male was 21.04 ± 12.95. The recurrence was observed in 2 (10%) of the patients treated with endoscopic technique and 1 (5%) of the patients treated with trans-cranial approach. Those patients were successfully repaired in a second operation. Overall success rate was 92.5%. One patient (2.50%) among the trans-cranial approach develops infection which was treated successfully.

Conclusion:  The endoscopic repair of CSF leak is both safe and effective and should be considered as the standard procedure of choice in most of the cases.


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