Lingering Issues: Challenges remain in repairing CSF leaks

“It is really important for otolaryngologists to know that if an otolaryngologist inadvertently creates a CSF leak during sinus surgery, that leak should be closed as early as possible unless there is any suspicion of intracranial bleeding,” he said.

Another key to achieving a successful closure, he said, is to prepare the surface so that the graft or flap can be placed on a nice flat surface right on the skull base.

For Dr. Takashima, the first step is to find the origin of the leak. “Don’t expect to just lay tissue over a large portion of the skull base in hopes of sealing the leak. Usually this results in failure,” he said.

Dr. Takashima also emphasized that sometimes the dura over a small CSF leak has to be opened up more to perform a good “bath plug” surgical repair.

“Although this sounds counterintuitive when repairing a leak,” he said, “the fat needs to be initially placed inside the cranium prior to pulling it back out to seal the leak. If the dura is not adequately opened enough to do this, a failure is more likely to occur.”