• Fabio Pagella, Alessandro Pusateri, Elina Matti, Cesare Zoia, Marco Benazzo, Paolo Gaetani, Diego Cazzador, Tiziana Volo, Daniele Borsetto, and Enzo Emanuelli.
• Department of Otorhinolaryngology, Fondazione I.R.C.C.S. Policlinico San Matteo, University of Pavia, Pavia, Italy.
• World Neurosurg. 2016 Feb 1; 86: 470-7.

ObjectiveSpontaneous cerebrospinal fluid leaks are most commonly located along the anterior skull base. Sphenoidal localization is less common, and clival localization is even rarer. We analyzed a group of patients with spontaneous leaks and selected patients with clival localization. This article discusses surgical management of these entities and provides a brief literature review regarding spontaneous clival leaks.MethodsOf a cohort of 67 patients who presented to our departments with a spontaneous leak during the period 2005-2014, a retrospective data analysis was performed on 6 patients with clival localization of the defect. A skull base repair with a multilayered reconstruction was performed in 3 patients, and a single-layered reconstruction using a pedicled nasoseptal flap was performed in 3 patients.ResultsThe patients included 6 women with a mean age of 60 years (range, 36-91 years). The mean length of the follow-up period was 69.5 months (range, 22-114 months). The overall success rate of the primary endoscopic repair was 83.3% (5 of 6 patients); this increased to 100% after revision surgery.ConclusionsThis series, although numerically limited, suggests that a minimally invasive endoscopic repair of idiopathic clival leaks may be accomplished with an acceptable rate of morbidity and excellent outcomes. Moreover, the pedicled nasoseptal flap has been confirmed to be the "workhorse" for the reconstruction of clival defects.Copyright © 2016 Elsevier Inc. All rights reserved.

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