Spontaneous CSF leaks are a rare entity. In this paper, a Spanish group report their experience managing the condition using endoscopic surgery in 35 patients over an eight year period. Leak locations included the cribriform plate (18/35), ethmoid roof (15/35) and the lateral recess of the sphenoid sinus (2/35). The authors used a three-layer closure including a vascularised nasoseptal flap for defects larger than 5mm and a two-layer closure if less than 5mm. All patients had a lumbar drain inserted at the time of surgery for a period of 72 hours. Finally, all patients received oral acetazolamide for 6-8 months and seven days of prophylactic antibiotics postoperatively. The group had an impressive 97% (34/35) successful repair rate. The key learning point from the paper is the fastidious management of the raised intracranial pressure using the techniques above. Repair of spontaneous CSF leaks can have a low success rate if this is not taken into account.
Managing spontaneous CSF leaks secondary to benign intracranial hypertension
Reviewed by Sidhartha Nagala
Spontaneous cerebrospinal fluid leaks in the anterior skull base secondary to idiopathic intracranial hypertension. Martinez-Capoccioni G, Serramito-Garcia R, Martin-Bailon M, Garcia-Allut A, Martin-Martin C.
