Craniotomy Versus Endoscopic For CSF leak

[rhon271b]

Hi, I am scheduled soon for a left temporal craniotomy to repair a CSF leak. The surgeon said there is a hole in my skull. I have had several leaks in the past 10 years, on the ventricles, near the back of my head...and what appears to be two reoccurences--all were addressed endoscopically. I notice morbidity is a concern for craniotomies, complications,...and it does not appear to have a higher success rate; but the surgeon indicates endoscopic repairs are not successful for holes in the skull. He said it is likley a congenital defect, but none of the tests or doctors before mentioned this before. No trauma to the head that can be associated with it. Can such a hole be repaired succussfully by the endoscopic method? Also, i suffer from Trigeminal Neuralgia, the surgeon believes it may also help with this but the risks associated with the craniotomy seem so much higher. I have had 3 CSF surgeries so far, and a couple of leaks resolved on their own. However, this hole (near the Sphenoid sinus) is a different issue.Thank you for your opinions.

[rhon271b]

Thank you horselip. The endocsopic method is definitely the least invasive and I am glad your surgery was successful! None of my previous CSF surgeries involved putting tissue unto the skull base (that I am aware of but... working on tracking down my ENT),. Reading all the associated risks and recovery time on the craniotomies; I feel almost compelled to try at least once the endoscopic method on the skull, if it was not previously done on this particular hole. Reading several research articles and medical sites, the endoscopic method has a very high success rate. I could not find however material concerning spinal fluid leaking out of the skull into the sinus, so as to whether the patch of tissue will adhere to bone is the issue for me.  I am seriously considering canceling the craniotomy if an attempt was never made on my skull, for it seems the same type of tissue will be placed on the skull by the ENT or neurosurgeon, but only the method of entry will differ. Thanks horselip for your repsonse, and my prayers are with you for a complete recovery and success!

[horselip]

I just had a CSF leak repaired that was near the sphenoid sinus. it was done using an endoscope and I had a very good ENT surgeon. The surgeon entered through my nose. I had several surgeons read my MRI's, cisternogram and indium scan. There were differing opinions. So a patch was put in using my own sinus tissue into my skull base. Whether it will hold or not, I don't know. It's now been about six weeks and so far so good. If my scans had shown that the leak was further back along the sphenois sinus then it would not have been able to be accessed this way. If that was the case, then a craniotomy would have needed to have been done. I don't think that, as a patient I can answer what the best approach to your leak is? But if you are uneasy, I would get another opinion. Also fixing this CSF leak did help my headaches but there was nothing done typical for Trigeminal Neuralgia like a nerve block.
Good luck