CSF leak is a serious condition caused by an abnormal communication between the subarachnoid space and the nasal cavity or paranasal sinuses. It may result from traumatic injuries, surgical complications, tumors, or spontaneous skull base defects. If not diagnosed and managed properly, CSF leaks can lead to life-threatening complications such as bacterial meningitis and recurrent infections. Prompt identification and appropriate repair are critical to prevent these adverse outcomes

With advances in endoscopic techniques, the management of CSF leaks has shifted from open cranial procedures to minimally invasive endonasal approaches. Endoscopic skull base surgery offers improved visualization, reduced morbidity, shorter hospital stays, and excellent cosmetic results compared to traditional transcranial methods. It has become the gold standard for most anterior and middle skull base CSF leak repairs.

The primary objective of this presentation is to provide a comprehensive overview of the endoscopic management of CSF leaks. The lecture will cover the common etiologies of CSF leaks—including traumatic, iatrogenic, and spontaneous cases—and the clinical signs such as clear rhinorrhea, positional headache, and recurrent meningitis. The importance of a thorough diagnostic workup will be emphasized, particularly the role of beta-2 transferrin testing, high-resolution CT scans, MRI, and CT cisternography. Intrathecal fluorescein may also be discussed as a valuable tool for intraoperative localization of the leak site

Surgical indications will be clearly defined, with a focus on factors such as the size and location, flow rate of the leak, and associated anatomical variations. Step-by-step surgical techniques will be demonstrated, including debridement, identification of the defect, and closure using various grafting materials such as fat, fascia lata, and synthetic dural substitutes. The use of multilayer repair strategies will be highlighted for high-flow or large defects

Intraoperative tools, including angled endoscopes, image-guided navigation, and micro-instruments, significantly enhance surgical precision

Participants will gain insight into the management of complex or recurrent leaks, complications such as pneumocephalus and infection, and long-term follow-up protocols. Success rates for endoscopic repair are generally high, with over 90% success reported in experienced hands

This session targets ENT surgeons, neurosurgeons, rhinologists, residents, and skull base surgery teams. It aims to equip attendees with practical knowledge and surgical strategies for effective, safe, and long-lasting management of CSF leaks through endoscopic techniques

In conclusion, endoscopic repair of CSF leaks is a safe and highly effective technique that has become the preferred method for most skull base defects. A multidisciplinary approach, careful patient selection, and adherence to surgical principles are key to achieving optimal outcomes and preventing recurrence. CSF leak is a serious condition caused by an abnormal communication between the subarachnoid space and the nasal cavity or paranasal sinuses. It may result from traumatic injuries, surgical complications, tumors, or spontaneous skull base defects. If not diagnosed and managed properly, CSF leaks can lead to life-threatening complications such as bacterial meningitis and recurrent infections. Prompt identification and appropriate repair are critical to prevent these adverse outcomes.

Endoscopic Pituitary Surgery – Global perspective from high to low resource settings

Abstract:

This lecture will focus on the surgical treatment of pituitary adenomas using a video-based teaching format. Pituitary adenomas are among the most common intracranial tumors, and endoscopic transsphenoidal surgery remains the gold standard approach for their removal. By integrating high-definition intraoperative videos, this session aims to enhance understanding of key surgical steps, anatomical landmarks, and complication management.

Objectives:

- To review the classification, clinical presentation, and radiologic features of pituitary adenomas.
- To demonstrate the surgical anatomy relevant to the transsphenoidal approach.
- To illustrate the step-by-step technique of endoscopic pituitary adenoma resection using operative videos.
- To discuss potential complications and their prevention strategies.
- To offer a practical insight into decision-making during surgery.

Format:

The presentation will be a 7-minute session, including narrated surgical videos and clinical case correlations.

Target Audience:

Neurosurgeons, ENT surgeons, endocrinologists, neurology residents, and medical students with an interest in neuroendocrinology or skull base surgery.

Expected Outcome:

Participants will gain practical surgical insights into pituitary adenoma resection, develop a better understanding of skull base anatomy, and be more prepared to manage these tumors surgically or in a multidisciplinary team setting