Endoscopic Management of Spontaneous Clival Cerebrospinal Fluid Leaks: Case Series and Literature Review

Fabio Pagella, Alessandro Pusateri, Elina Matti, Cesare Zoia, Marco Benazzo, Paolo Gaetani, Diego Cazzador, Tiziana Volo, Daniele Borsetto, Enzo Emanuelli

Research output: Contribution to journalArticlepeer-review


Objective Spontaneous cerebrospinal fluid leaks are most commonly located along the anterior skull base. Sphenoidal localization is less common, and clival localization is even rarer. We analyzed a group of patients with spontaneous leaks and selected patients with clival localization. This article discusses surgical management of these entities and provides a brief literature review regarding spontaneous clival leaks. Methods Of a cohort of 67 patients who presented to our departments with a spontaneous leak during the period 2005-2014, a retrospective data analysis was performed on 6 patients with clival localization of the defect. A skull base repair with a multilayered reconstruction was performed in 3 patients, and a single-layered reconstruction using a pedicled nasoseptal flap was performed in 3 patients. Results The patients included 6 women with a mean age of 60 years (range, 36-91 years). The mean length of the follow-up period was 69.5 months (range, 22-114 months). The overall success rate of the primary endoscopic repair was 83.3% (5 of 6 patients); this increased to 100% after revision surgery. Conclusions This series, although numerically limited, suggests that a minimally invasive endoscopic repair of idiopathic clival leaks may be accomplished with an acceptable rate of morbidity and excellent outcomes. Moreover, the pedicled nasoseptal flap has been confirmed to be the "workhorse" for the reconstruction of clival defects.

Original languageEnglish
Pages (from-to)470-477
Number of pages8
JournalWorld Neurosurgery
Publication statusPublished - Feb 1 2016


  • CSF leaks
  • CSF rhinorrhea
  • Endoscopic skull base surgery
  • Skull base repair
  • Sphenoid sinus

ASJC Scopus subject areas

  • Clinical Neurology
  • Surgery


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