The most common defect was in the lateral sphenoid sinus, which was present in 23 patients; ethmoid roof defects were documented in 14 patients. In the remaining patients, 11 had defects in the cribriform plate and seven each had central sphenoid and frontal sinus defects. Among these patients, nine had multiple CSF leaks at the time that they were treated, and the vast majority, 50 patients (94%), had associated encephaloceles.
In 28 months of follow-up, 50 patients (94%) had successful repairs at the first attempt without recurrences. The lumbar drain pressures were recorded on 40 of 53 patients, who had an average of 27.9 cm of water. To address the intracranial hypertension, the treating physicians used acetazolamide or, in severe cases, a ventriculoperitoneal shunt.
Bone Grafts Provide Stronger Support
Although there are multiple approaches to repair leaks in the setting of elevated CSF pressure, the goal should be a mechanism that gives stiffer, stronger support than was present before the leak, Dr. Palmer said. Therefore, we recommend using bone in the closure, he said. The bone tissue should be autologous, and can be harvested from the septum, mastoid tip, or turbinate.