Outcomes of endoscopic repair for spontaneous CSF rhinorrhea: A 10-year single-center review

Objective: To evaluate the surgical outcomes, complications, and grafting strategies in patients undergoing endoscopic endonasal repair of spontaneous cerebrospinal fluid rhinorrhea (sCSFr) at a tertiary center in Qatar. Study Design: A retrospective cohort study. Setting: A tertiary care academic hospital in Qatar. Methods: Adult patients (≥18 years) treated for sCSFr between January 2015 and April 2025 were retrospectively reviewed. Diagnosis was confirmed using β2-transferrin testing and/or radiological imaging. All patients underwent endoscopic endonasal repair with a standardized multilayer technique using a Haddad nasoseptal flap, reinforced with autologous fat and fascia. Intraoperative lumbar drains were placed according to institutional protocol. Outcome measures included leak site, timing of diagnosis and repair, complications, and length of hospital stay. Results: Eighteen patients were included. The cribriform plate was the most frequently identified defect site. Eleven patients underwent surgical repair within one week of diagnosis. Three patients had a prior history of meningitis. Postoperative complications were limited: one patient developed meningitis, and one experienced a recurrence; both were successfully managed. The median hospital stay was 12 days. Lumbar drains were removed within 4–9 days, and one patient subsequently required a lumboperitoneal shunt. No graft failures were reported. Conclusion: Endoscopic endonasal repair of sCSFr demonstrated favorable outcomes comparable to international standards. The procedure was associated with low rates of complications and recurrence. Routine use of lumbar drainage was well tolerated, although selective application in high-flow leaks may further optimize patient care. Further investigation is warranted regarding the use of synthetic dural substitutes, such as ReDura®.