Management of cerebrospinal fluid leaks

Publisher Website
Google Scholar
Abstract
Since its first description in the second century AD by Galen as a normal physiologic process, the diagnosis and management of cerebrospinal fluid (CSF) rhinorrhea continues to evolve. The original repair of CSF leaks was accomplished intracranially. Extracranial techniques were developed to avoid the morbidity of a craniotomy and to improve success rates. The advent of endoscopic sinus surgery has greatly impacted the management of CSF leaks. This procedure is responsible for the majority of iatrogenic causes of CSF rhinorrhea, yet it also provides a safe and highly effective treatment for this problem. Advances in the management of CSF leaks have paralleled advances in diagnostic modalities. Successful surgical repair of CSF leaks depends greatly on accurate preoperative localization. High-resolution CT scans, MR cisternography, and CT cisternography all have their role in the diagnosis and localization of CSF leaks. Newer techniques continue to be developed and need to be evaluated further. In this paper, the latest approaches to the diagnosis and management of CSF leaks are reviewed.