Cerebrospinal Fluid Leaks: A Review of Surgical Management and Repair Techniques

Abstract

We present a review of cerebrospinal fluid (CSF) leak repairs carried out at our institution. A total of 12 cranial CSF leak repair procedures were carried out on nine patients in the ENT and Neurosurgical Department between 2008 and 2011. Three cases were spontaneous leaks and seven occurred after a neurosurgical procedure. The most common location of the leak was the pituitary fossa floor (n = 5). The other leaks occurred from the cribriform plate (n = 2), posterior ethmoid (n = 1), and mastoid air cells (n = 1). The spontaneous leaks occurred through the cribriform plate in a patient with congenital hydrocephalus and transsphenoidal and posterior ethmoid. A single repair procedure successfully controlled the leak in six patients. A second procedure was required in three cases. A fibrin sealant was used in all cases, and a fat graft was used in all but one case. The use of fluorescein dye to identify CSF leaks is a relatively new technique. This was used in one case to identify the CSF leak intraoperatively. Endoscopic repair was the technique of choice in all procedures except for two cases, and those two underwent open repair. Endoscopic sinus surgery is becoming common practice; as a result, the incidence of iatrogenic CSF leaks has increased. The comparatively low morbidity and high success rate of endoscopic repair has made it the treatment of choice for CSF leak repair. It is important that endoscopic sinus surgeons be aware of the various techniques available in identifying and closing such leaks.