2026 Poster Presentations
P257: SEALING SUCCESS: ENDOSCOPIC CSF LEAK REPAIR IN LMICS, THE WAY WE DO IT
Lucien Khalil, MD; Lynn Abdel Malak, MD; Houssein Darwish, MD; Zeina Korban, MD; American University of Beirut
Introduction: Cerebrospinal fluid (CSF) leak is a well-known complication of endoscopic endonasal approaches (EEA) for skull base surgery, resulting from dural breach during tumor removal. Persistent leakage can lead to serious complications such as meningitis, pneumocephalus, and the need for revision surgery. Various reconstructive techniques have been developed to minimize this risk, with multilayer repair methods now widely adopted. In low- and middle-income countries (LMICs) like Lebanon, cost-effective and robust approaches utilizing various synthetic and autologous grafts are particularly important. At the American University of Beirut Medical Center (AUBMC), a tertiary care center in Beirut, Lebanon, repairs were performed using a unique standardized multilayer technique that combines autologous fascia lata, a rigid buttress (septal cartilage) applied as a gasket-seal, and a vascularized nasoseptal flap. This study describes our gasket-seal reconstructive technique and reports the outcomes of endoscopic CSF leak repair over a seven-year period.
Methods: We retrospectively reviewed adult patients who underwent endoscopic CSF leak repair at the otorhinolaryngology and neurosurgery departments, AUBMC, between November 2018 and July 2025. The diagnosis was established through clinical history, physical examination, radiologic imaging, and intraoperative findings. Patients with spontaneous leaks or a history of head trauma were excluded.
Results: Out of 138 patients, we included 107 patients in the study after excluding trauma cases and spontaneous CSF leaks. 59 women (55.1%) with a mean age of 46.4 ± 14.1 years and 48 men (44.9%) with a mean age of 44.8 ± 16.5 years. Twenty-five patients (23.4%) were undergoing revision surgery at the time of inclusion. Intraoperative CSF leaks were encountered in 32 cases (29.9%), 10 of which (9.4%) were high-flow. Multilayer closure was performed in 34 patients (31.8%), and a gasket seal was used in 21 cases (19.6 %). Postoperative CSF leak requiring a repair surgery occurred in only one patient (1.9%). No other complications were encountered.
Conclusion: Our gasket-seal multilayer endoscopic CSF leak repair technique is safe, efficient, and cost-efficient with low postoperative leak rates and complications, rendering it a reliable reconstructive approach, particularly in low- and middle-income countries.
Image 1: Fascia lata was placed over the bony defect in an inlay/onlay fashion and covered with harvested septal cartilage.
Image 2: Nasoseptal flap was positioned over the fascia lata and nasal cartilage.
Image 3: Surgicel and fibrin glue were applied followed by an outer layer of Surgicel and gelfoam.
