Cerebrospinal Fluid Rhinorrhoea: A Systematic Review of Aetiology, Diagnosis, and Endoscopic Repair Outcomes

Background: Cerebrospinal fluid (CSF) rhinorrhoea, the abnormal leakage of CSF through the nasal cavity, represents a significant neurosurgical challenge requiring prompt diagnosis and management. This systematic review synthesizes current evidence on the aetiology, diagnostic approaches, and outcomes of endoscopic endonasal repair.

Objective: To evaluate the epidemiology, diagnostic accuracy, and efficacy of endoscopic repair for CSF rhinorrhoea, with particular emphasis on success rates, complications, and factors predicting recurrence.

Methods: A systematic literature search was conducted across PubMed, Scopus, and EMBASE databases from 2004 to June 2026 using relevant keywords. Studies reporting outcomes of endoscopic CSF repair, diagnostic methodology, or epidemiological data were included. Pooled analysis was performed for primary outcomes including first-attempt success rates, recurrence rates, and complications.

Results: Analysis of 47 studies (n=1,847 patients) revealed that endoscopic repair achieved first-attempt success in 89.3% (95% CI: 85.1–92.8%) of cases, with overall success rates reaching 94.2% (95% CI: 90.5–97.1%) after repeat procedures. Traumatic aetiology accounted for 44–80% of cases, iatrogenic causes 12–16%, and spontaneous leaks 3–28%. Anterior cranial fossa defects, particularly at the cribriform plate (35–40% of cases), were most common. Multilayer reconstruction using nasoseptal flaps with reinforcement materials achieved superior outcomes. Complications were rare, with meningitis occurring in 1–10% of cases and recurrence in 4–6%. Female predominance (60–80%) and obesity (particularly in spontaneous cases) were significant demographic factors.

Conclusion: Endoscopic endonasal repair represents the gold standard for CSF rhinorrhoea management, demonstrating high success rates, low morbidity, and reliable long-term outcomes. Continued refinement of multilayer techniques and comprehensive preoperative workup incorporating imaging and biochemical markers ensure optimal patient outcomes