The long-term outcomes of surgical approaches for managing cerebrospinal fluid rhinorrhea: a systematic review and single-arm meta-analysis.

backgroundCerebrospinal fluid (CSF) rhinorrhea is a clinically significant condition resulting from abnormal communication between the subarachnoid space and the nasal cavity. Although multiple surgical techniques have been developed, their long-term outcomes remain inadequately defined. Our systematic review and meta-analysis aimed to assess the long-term efficacy and safety of surgical interventions used to manage CSF rhinorrhea.

methodsA comprehensive search of PubMed, Scopus, Web of Science, and the Cochrane Library was conducted from database inception to March 2025. Studies evaluating any surgical interventions for managing CSF rhinorrhea and following the patients for at least one year were included. Our study outcomes were success, recurrence, and complication rates. All statistical analyses were performed using STATA 18 BE.

resultsOur review encompassed 114 studies involving 4187 patients with CSF rhinorrhea. The endoscopic repair demonstrated a high primary success rate, estimated at 93% (1-2 years), 92% (2-5 years), and 91% (more than 5 years). Recurrence after endoscopic repair remained low, varying from 7% to 11%. Complications were uncommon, with meningitis reported in 1-2% of cases, sinusitis estimated at 1%, and headache from 1 to 3%. The craniotomy approach achieved a high primary success rate, reaching 95% at 1-2 years, then dropping to 75% at 2-5 years, and increasing again to 98% at > 5 years. Additionally, the risk of recurrence (5-22%) and complications were generally higher after craniotomy (3-6%).

conclusionEndoscopic repair demonstrated excellent long-term outcomes with minimal morbidity, supporting its role as the standard approach for most CSF rhinorrhea cases. Although craniotomy carries a higher risk of recurrence and complications, it remains appropriate for complex or frontal defects. Surgical management should be individualized according to defect site, CSF flow, and patient-specific factors to optimize outcomes. Nevertheless, we have some limitations as most included studies were observational and retrospective, and there was heterogeneity in study design and outcome reporting.