Postoperative Cerebrospinal Fluid Leak and Meningitis after Endoscopic Endonasal Skull Base Surgery: Complications at the Otorhinolaryngology–Neurosurgery Interface
Keywords:
endoscopic, skull base, cerebrospinal, complications, meningitis, pituitary, reconstruction, otorhinolaryngologyAbstract
Endoscopic endonasal approaches (EEA) to the skull base have transformed the management of pituitary and anterior skull base lesions but introduce distinctive otorhinolaryngologic complications, notably cerebrospinal fluid (CSF) leak and postoperative meningitis. Reported CSF leak and meningitis rates after transnasal endoscopic skull base surgery range around 7–8% in some series, with frequent concurrent occurrence and substantial associated morbidity. These complications arise from dural defects, high-flow CSF states, and imperfect skull base reconstruction, and are modulated by lesion pathology and prior treatments. This narrative review summarizes current evidence on incidence, risk factors, diagnostic strategies, and preventive as well as therapeutic measures for CSF leak–related complications in EEA. Emphasis is placed on reconstruction techniques, perioperative antibiotic strategies, and structured follow-up tailored to high‑risk populations such as patients with ACTH‑secreting adenomas. Remaining gaps include heterogeneous definitions of CSF leak, variable follow‑up, and limited pediatric data.
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