What is the optimal approach and perioperative care for repair of skull base spontaneous cerebrospinal fluid (sCSF) leaks?
Endoscopic repair of anterior skull base leaks and MCF or transmastoid approaches for lateral skull base leaks have a high success rate of repair. In most cases, intraoperative placement of lumbar drain did not appear to result in improved success rates for either anterior or lateral skull base leaks
Explore this issue:May 2017
Background: The clinical presentation of sCSF leak should be recognized, and its diagnosis involves a combination of clinical history, a skull base defect on high resolution computed tomography (CT) and associated clear pulsatile otorrhea or clear rhinorrhea. Unlike traumatic or iatrogenic leaks, sCSF leaks are highly associated with obesity and idiopathic intracranial hypertension. The safety and efficacy of surgical treatment of sCSF leaks has not been systematically evaluated, and the use of intra-operative fluorescein and peri-operative CSF diversion are controversial.
Study design: A systematic review of English articles using MEDLINE. Search terms included spontaneous, CSF, cerebrospinal fluid, endoscopic, middle fossa, transmastoid, leak, rhinorrhea. Independent extraction of articles by three authors.