الفهرس 
ACKNOWLEDGMENTOnly 14 pages are availabe for public view
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Abstract
CONCLUSION AND RECOMMENDATION
from the study, we conclude that
● Endoscopic endonasal surgery for the closure of skull base defects is an effective technique.
● Proper diagnosis of the cause and site prior to the endoscopic endonasal repair of skull base defects is mandatory before any surgical interference.
● Proper diagnosis and treatmentof high CSF pressure leaks is mandatory before and after surgery to achieve better surgical outcome.
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● The use of multilayerrepair reinforces the skull basedefect site.
● Followup must be extended over several years with larger studies needed.
SUMMARY
Cerebrospinal fluid rhinorrhea (CSF), classically described as the leakage of CSF from the nose, indicates an opening of arachnoid and dura with an osseous defect leading to a communication of subarachnoid space with the nose.
Etiologies of CSF leak can be generally divided into traumatic (including both iatrogenic and non-iatrogenic) and congenital, tumor-related, and spontaneous causes.
Treatment of the CSF rhinorrhea is essential because of the risk rate of meningitis from untreated CSF leakage which varies from 10% to 40% in long-term follow-up.
Surgical repair of cerebrospinal fluid rhinorrhea includes transcranial (craniotomy) or extracranial (nasal) approaches which includes external ethmoidectomy, endonasal ethmoidectomy and endoscopic endonasal approach.
Endoscopic endonasal techniques have emerged as the preferred approach to the repair of skull base defects. This approach provides excellent exposure of the ethmoid roof, cribriform plate, the sphenoid sinus and frontal sinus, in addition to its several advantages, including excellent visualization and identification of the defect as well as graft placement, better lightning, magnification of the image and best angle visualization, which gives the surgeon a more precise diagnosis and a less invasive method of nasal CSF fistula treatment, giving the endoscopic surgery a status of the method of treatment choice.
Aim of the work To assess the surgical efficacy of endoscopic approach in repairing skull base osteodural defect causing CSF rhinorrhoea by using multilayer different materials.
This study included forty-five patients with CSF rhinorrhea due to different causes. Forty-four cases were operated endoscopic endonasally alone or combined with external approach.
All patients had complete history taken, complete general and neurological examination, and an informed consent was signed for each patient. Preoperatively, all patients had routine laboratory investigations; multislice thin cuts computed tomography (CT scan) and/or magnetic resonance imaging (MRI) of the brain, paranasal sinuses and skull base.
Objective surgical data were obtained. It included materials used for repair, type of repair. Postoperatively, assessments for leak and/or complications were done weekly at 1st month, and then monthly for one year.
This study included 45 cases, included 23 (51.1%) females and 22 (48.9%) males, with mean age of40.3±16.6 years. All cases presented with CSF rhinorrhea, headache in (80%) of cases,18(40%) were spontaneous CSF rhinorrhea, 21(46.7%) were post-operative (Iatrogenic) CSF leak, 4(10.9%) were post accidental trauma,1 patient (2.2%) was post tumor and 1 patient (2.2%) was congenital.
The present study included 1 (2.27%) cases had persistent CSF leak; due to persistent elevated CSF pressure with no response to medical treatment and re-operated with multilayer endoscopically repair and insertion of ventriculo peritoneal shunt with successful closure of the defect and cure of the condition.
Endoscopic endonasal repair was successful in preventing CSF leak in (97.7%) patients. Following repeat endoscopic repair in additional case the success rate increased to 100%.
There was no significant difference between different repair materials or between type of repair (overlay/underlay repair and overlay repair alone) in correlation to failure of repair.
So we conclude that Endoscopic endonasal surgery for the closure of skull base defects is an effective technique and the use of multilayer repair reinforce the skull base defect site.