CSF fistulas of the anterior skullbase from the neurosurgeon’s perspective

Cerebrospinal fluid (CSF) fistulas of the anterior skullbase represent an abnormal communication between the subarachnoid space and the paranasal sinuses, carrying a high risk of recurrent meningitis and significant morbidity. Diagnosis relies on clinical, biochemical and imaging correlation, with specific markers such as beta-2 transferrin and advanced CT and MRI techniques. The conservative management is appropriate for acute cases, whereas persistent or complicated fistulas require surgical repair, preferably through an endoscopic endonasal approach. Interdisciplinary collaboration between the neurosurgeon and the ENT team is crucial for optimal outcomes, with a favorable prognosis when early diagnosis and appropriate intracranial pressure control are ensured.