Cerebrospinal Fluid Leaks Following Anterior Skull Base Trauma: A Systematic Review of the Literature

World Neurosurg. 2021 Oct 9;S1878-8750(21)01562-X. doi: 10.1016/j.wneu.2021.10.065. Online ahead of print.


Background: Anterior skull base (ASB) fractures are reported in 4% of head injuries and represent 21% of all skull fractures. Cerebrospinal fluid (CSF) leaks may follow, severely exacerbating outcomes. We systematically reviewed the literature to analyze and compare the roles of endoscopic surgery, open surgery, and combined approaches in the management of CSF leak repair following post-traumatic ASB fractures.

Methods: PubMed, Web of Science, and Scopus databases were searched in accordance with the PRISMA guidelines. Studies reporting clinical data of patients with CSF leaks following ASB fracture were reviewed, focusing on management strategies and post-treatment outcomes.

Results: We included 29 articles comprising 888 patients. The average age at diagnosis was 34 years (range 18-91), with a male predominance (54%) and a male/female ratio of 2.9:1 (647/241). Clinical data was available for 888 patients with CSF leaks post-ASB fracture, reporting a median follow-up time of 33.5 months (SD: ±29; range 0.5-330.0 months). Open surgical repair was the most common approach (67.9%), followed by endoscopic surgical repair (32.1%). The endoscopy cohort showed lower rates of complications (0.7% vs. 11.1%) and fistula recurrence (2.8% vs. 5.3%) compared to open surgery.

Conclusion: ASB fractures are frequently treated as late surgery, 24 hours from injury or later, especially for endoscopic surgery. The endoscopic approach is overall preferred, mostly because of its safety and effectiveness, offering lower failure rates than open surgery.

Keywords: Anterior Skull Base; Cerebrospinal Fluid Leak; Craniofacial Trauma; Endoscopy; Skull Base Fracture.

Publication types

  • Review