Outcomes of Endoscopic Management of Spontaneous Cerebrospinal Fluid Rhinorrhea: A Meta-Analysis.

OBJECTIVE: Although endoscopic surgery has advanced the treatment of cerebrospinal fluid (CSF) rhinorrhea, spontaneous leaks remain challenging due to their higher recurrence rates compared to other etiologies. This systematic review aims to identify factors influencing surgical success. DATA SOURCES: Medline, Embase, Cochrane, and Web of Science were searched on 26 October 2024, and updated on 9 June 2025. REVIEW METHOD: A meta-analysis was conducted to estimate the pooled success rates, and meta-regression was used to explore the impact of demographic and surgical factors. Study quality was appraised using the JBI critical appraisal tool. RESULTS: A total of 47 studies, encompassing 2586 patients, met the inclusion criteria. The pooled primary repair success rate was 93.7% (95% CI 91.5%-95.7%), and the overall success rate after revision surgery was 99.7% (95% CI 98.9%-100%). Multilayer reconstruction demonstrated higher success rates (94.6%, 95% CI 91.6%-97.1%) compared to single-layer techniques (87.6%, 95% CI: 77.7%-95.1%), although the difference was not statistically significant (p = 0.09). Perioperative lumbar drain use did not significantly affect outcomes (p = 0.4). Skull base defects involving the sphenoid sinus were associated with lower success rates (p = 0.0004). The overall quality of evidence was moderate. CONCLUSIONS: Endoscopic repair remains the gold standard for managing spontaneous CSF rhinorrhea. Reconstruction technique and lumbar drain use did not significantly influence surgical success. Randomized controlled trials are warranted to validate these findings. LEVEL OF EVIDENCE: N/A.