The use of prophylactic antibiotics in patients with traumatic CSF fistulas remains controversial. [70] Caudal displacement of cerebellar tonsils and obliteration of the basal cisterns are usually present. The presence of hydrocephalus may be difficult to assess in patients with an active CSF leak. During reexploration intraoperatively, the fascia lata graft was inspected and studied, which has shown the healing of the dura graft site and the graft neovascularization. Article. High-pressure leaks related to longstanding increases in intracranial pressure (ICP) account for about 45% of spontaneous CSF leaks. The closure technique is a strictly related to the individual patient’s anatomy, the size of the leak, and its anatomical location. 1. The patient is seen 4 weeks and then every 3-6 month in the first 2 postoperative years. Surgical ligation of leaking meningeal diverticula has been associated with good outcomes. Beyond the age of 5 years, the frontal air sinuses progressively enlarge reaching adult dimensions by 14 years of age. The diagnosis and management of the patient with a cerebrospinal fluid (CSF) leak depend on the location of the leak, its etiology, and the patient’s presenting symptoms. Management depends on the suspected location, cause, and presenting symptoms of the CSF leak. Traumatic spinal CSF leaks include iatrogenic lesions resulting from surgical, therapeutic, or diagnostic procedures. The endoscope is inserted in the nostril (right, left, or both) and the anatomical landmarks are visualized.The use of navigational devices (fusion data sets, CT, and MRI) is helpful. A fascia lata graft was the dominant choice for defect closure, and it was combined with a conchal or septal flap, fat, periosteum, or fibrin glue in 15 patients. [5] Under such circumstances, the presence of the specific CSF marker, b2-tranferrin, is diagnostic for a CSF fistula. Ear Nose Throat J 71:292-299, 1992, Blank SC, Shakir RA, Bindoff LA, et al: Spontaneous intracranial hypotension: Clinical and magnetic resonance imaging characteristics. MR imaging studies of the spine may show extraaxial CSF collections that help localize the site of the leak, but experience with spinal MR imaging in patients with spontaneous spinal CSF leaks is limited.[51]. Spontaneous spinal CSF leaks can be difficult to diagnose, but the similarity of the symptoms to those of spinal headache after lumbar puncture should suggest the diagnosis. 2020 Mar 20;36(3):219-223. doi: 10.3760/cma.j.cn501120-20190505-00222. 2019 Oct;30(7):e671-e674. [1] Penetrating head injuries can also produce CSF leaks at any location. In such situations suturing fat, muscle graft, or autologous fascia lata graft over the repaired dural tear may reinforce the dural repair. Arch Surg 110:293-295, 1975, Villalobos T, Arango C, Kubilis P, et al: Antibiotic prophylaxis after basilar skull fractures: A meta-analysis. Found inside – Page 2412013;80(6):864-71. fascia lata graft. Visualization via endonasal endoscopy with fluorescein injection confirmed successful repair of the CSF leak. J Neurosurg 83:795-798, 1995, Fishman AJ, Hoffman RA, Roland JT, Jr., et al: Cerebrospinal fluid drainage in the management of CSF leak following acoustic neuroma surgery. Used in a multilayer strategy, it should be considered a viable alternative to an autologous fascia lata graft. Arch Otolaryngol Head Neck Surg 125:580-584, 1999, VanGilder JC, Goldenberg IS: Hypophysectomy in metastatic breast cancer. Coronal CT imaging can be helpful in patients with facial fractures that extend into the skull base. The choice of treatment depends on the etiology and severity of the CSF leak as well as on the timing and mode of presentation. J Neurosurg 92:873-876, 2000, McKusick KA, Malmud LS, Kordela PA, et al: Radionuclide cisternography: Normal values for nasal secretion of intrathecally injected 111In-DTPA. The bone defects can be repaired using septal cartilages, parts from the middle nasal turbinates, eventually the vomer, etc. Yoking the two sheets with the sutures in the appropriate Despite recognition that these symptoms are the result of spontaneous spinal CSF leaks, patients are grouped under the diagnosis of “spontaneous intracranial hypotension.”, Radionucleotide cisternography is fairly characteristic in patients with spontaneous spinal CSF leaks. In 1997 Brodie[10] published a meta-analysis suggesting that prophylactic antibiotics might be beneficial; however, numerous other studies, including a second meta-analysis in 1998 by Villalobos et al.,[81] have failed to demonstrate that they lower infection rates. Arch Surg 12:949-982, 1926, El Gammal T, Sobol W, Wadlington VR, et al: Cerebrospinal fluid fistula: Detection with MR cisternography. The treatment of CSF fistulas can be divided into nonoperative and operative management. Clin Infect Dis 27:364-369, 1998, Wormald PJ, McDonogh M: ‘Bath-plug’ technique for the endoscopic management of cerebrospinal fluid leaks. [37,65] Ultimately, combined intra- and extradural approaches may be necessary. Am J Rhinol 14:93-96, 2000, Kadrie H, Driedger AA, McInnis W: Persistent dural cerebrospinal fluid leak shown by retrograde radionuclide myelography: Case report. Found inside – Page 165... to large dural defect Fascia lata Posterior frontal sinus wall graft, ... Common complications of CFR are CSF leak, meningitis, brain herniation and ... Sometimes the presence of a CSF leak is obvious, as in the case of acute trauma associated with pneumocephalus, but it can also be extremely challenging to diagnose. Anosmia is a common complaint, particularly when the cribriform plate is involved. Dural defects can be repaired directly by suturing, but autologous tissue grafts are frequently employed. Found inside – Page 222... autologous fascia lata graft, harvested from the patient's lateral thigh. ... of postoperative CSF leaks (Placantonakis et al., 2007; Snyderman et al., ... Treatment of spinal CSF fistulas follows the paradigm described for cranial CSF leaks. Found insideMultilayered fascia lata grafts have proven especially effective in management of open cisterns and other high-flow CSF leaks [1]. Bone or cartilage grafts ... The repair succeeded in 35 patients giving a success rate of 87.5%. Introduction. Disclaimer, National Library of Medicine uid (CSF) leaks. J Neurosurg 94:61-66, 2001, Spetzler RF, Wilson CB: Management of recurrent CSF rhinorrhea of the middle and posterior fossa. Although there is general agreement that CSF leaks after transsphenoidal pituitary surgery must be scrupulously avoided, a variety of opinions exist on how best to prevent this complication. J Neuro-Ophthalmol 15:79-83, 1995, Magliulo G, Sepe C, Varacalli S, et al: Cerebrospinal fluid leak management following cerebellopontine angle surgery. If the patient’s condition deteriorates, the drain should be closed immediately and the patient placed in a flat or slight Trendelenburg (head down) position. J Neurosurg 88:243-246, 1998, Sluyter S, Graamans K, Tulleken CA, et al: Analysis of the results obtained in 120 patients with large acoustic neuromas surgically treated via the translabyrinthine-transtentorial approach. Patients Since devising and testing this technique on cadavers two years ago, the authors have used it on all consecutive patients presenting with a CSF leak. The most used autologous extranasal graft is the abdominal fat or the fascia lata. Patient follow-up after discharge. Our experienced, highly skilled, and comprehensive team of neurological specialists can provide you with a complete spectrum of care–from diagnosis through outpatient neurorehabilitation–under one roof.Barrow Neurological Institute | Minding What Matters Most. [22,26,75] The early treatment of facial fractures may enhance the spontaneous resolution of traumatic CSF leaks while delayed reduction may lead to a recurrence. The authors prefer a vascularized periosteal graft, but fascia lata or various commercially available dural substitutes can be used. In contrast to traumatic CSF leaks, spontaneous CSF leaks are unlikely to respond to nonoperative intervention. [43,71] Recently, epidural patching with fibrin glue has been used to successfully treat patients with spontaneous spinal CSF leaks who were unresponsive to epidural blood patches.[47]. Headache 40:844-847, 2000, Kaufman B, Nulsen FE, Weiss MH, et al: Acquired spontaneous, nontraumatic normal-pressure cerebrospinal fluid fistulas originating from the middle fossa. The emergence of drug-resistant bacteria and reports of infection with more virulent organisms have heightened concerns about the indiscriminate use of antibiotics. 2019 Aug 20;19(3):297-303. doi: 10.17305/bjbms.2019.3949. J Otolaryngol 24:191-197, 1995, Godley CD, McCabe CJ, Warren RL, et al: Traumatic subarachnoid-pleural fistula: Case report. In the middle fossa, leakage can occur through air cells in the lesser sphenoid wing or floor of the temporal fossa. A clear understanding of their natural history is also mandatory for making sound management decisions. Fine 3 mm x 3 mm coronal CT sections are obtained. Duraplasty using autologous fascia lata reenforced by on-site pedicled muscle flap is an effective technique to control CSF leak, especially when dura is poorly vascularized and less viable. Laryngoscope 102:443-446, 1992, Jones ME, Reino T, Gnoy A, et al: Identification of intranasal cerebrospinal fluid leaks by topical application with fluorescein dye. Found inside – Page 113Free Mucosal Grafts One of the simplest methods of closing a CSF leak is with a ... Fascia lata • Anterior rectus sheath 9.1 Types of Free fascia grafts ... [7] The process of the formation, flow, and reabsorption of CSF is dynamic. Intracranial air is easily recognized on CT, and in the absence of an apparent leak provides evidence for the presence of a CSF fistula. The general rule of thumb is to begin with the least invasive treatment and escalate as necessary. [16] Under direct endoscopic visualization, a leak often can be identified and the sinus into which it drains can be obliterated by packing it with fat or muscle (Fig. Found inside – Page 332Optimal drainage lowers CSF pressure to decompress the leak; however, ... by using a bifrontal craniotomy for access and a fascia lata graft for repair. Like their cranial counterparts, CSF leaks involving the spinal axis can be divided into traumatic and nontraumatic (or spontaneous) categories. [62] Based on the available literature, the prophylactic use of antibiotics in patients with CSF leaks appears to be ineffective and cannot be recommended. Nontraumatic causes of normal pressure CSF leaks include intracranial tumors that directly invade the skull base, infections such as osteomyelitis and tuberculosis, meningoceles and meningoencephaloceles, and defective development or atrophy of the olfactory bulbs that exposes the thin perforated bone of the lamina cribrosa to pulsations of CSF. Found inside – Page 37A leak should be repaired using a small , running suture on an atraumatic needle ... the use of a fascial graft ( such as fascia lata ) covered with muscle ... Ear Nose Throat J 71:318-320, 1992, Zlab MK, Moore GF, Daly DT, et al: Cerebrospinal fluid rhinorrhea: A review of the literature. Medical treatment options include intravenous caffeine infusions, glucocorticoids, and various nonsteroidal anti-inflammatory agents, mineralocorticoids, and salt infusions. The etiology of most meningeal diverticula is unknown, and it is unclear whether these lesions are congenital or acquired. [Dura-plasty in intracranial operations]. [85] In 1826 Miller[54] noted nasal flow of spinal fluid in a child with hydrocephalus. CSF leaks were repaired with use of a fascia lata button graft and nasoseptal flap, without use of perioperative lumbar drains. The labeled pledgets are removed after 12 to 24 hours, and the level of radioactivity is counted. described performing a duraplasty combining a fascia lata autograft (free graft) with an on-site vascularized pedicle muscle flap (sutured to the fascia lata graft). Extracranial approaches are limited to the anterior cranial fossa and paranasal sinuses. In 1926, Dandy was the first to successfully repair a CSF fistula using a tensor fascia lata graft through a transcranial, intradural approach. The rates of CSF leaks associated with acoustic neuromas are 5 to 10%,[39,83] and those associated with transsphenoidal surgery are 3 to 6%. In the 1950s, radioactive isotopes were first used and injected into the CSF space for diagnostic purposes. Severe headaches, nausea, and vomiting often lead to MR imaging of the brain. The use of a fluorescein blue-light filter system and the fluorescein barrier filter mounted to the eyepiece of the endoscope might be helpful to visualize the localization of the dural defect. CSF leak First approach MFA sealed with bone wax and cov-ered with fascia second operation MFA The meningo-cele was reduced and the defect was plugged with an abdominal fat graft and fibrin glue. Zwirner J, Ondruschka B, Scholze M, Schulze-Tanzil G, Hammer N. Sci Rep. 2021 Jan 22;11(1):2127. doi: 10.1038/s41598-020-80448-1. Found inside – Page 1209The CSF leak may be managed by fat graft , lumbar drainage and acetazolamide administration . Occasionally , wound revision and closure with a fascia lata ... The most used autologous extranasal graft is the abdominal fat or the fascia lata. Using this simple approach, 70 to 85% of cases of traumatic CSF rhinorrhea will resolve within 7 days, and almost all cases of traumatic otorrhea will resolve.[11,55,60]. Conclusions: Duraplasty using autologous fascia lata reenforced by on-site pedicled muscle flap is an effective technique to control CSF leak, especially when dura is poorly vascularized and less viable. First, the fas- cial graft provides coverage of the presigmoid dural de- fect, thereby converting a large dural defect with a “high- flow” CSF leak state to a “low-flow” or minimal CSF leak state. [77] Where surgical confirmation has been available, the leaks have been the result of ruptured meningeal diverticula. Ever since the German otolaryngologist Malte Wigand pioneered the use of intraoperative endoscope for repair of spontaneous CSF rhinorrhea in 1981, [ 24 ] rapid advances in endoscopic techniques have popularized the use of endoscopy for repair of anterior cranial fossa CSF leaks. [ 6 ] Small defects can be filled with bone dust and fibrin glue. [85] Fractures through the floor of the anterior cranial fossa may extend directly into the paranasal sinuses. Otolaryngol Head Neck Surg 104:425-432, 1991, Bergman TA, Rockswold GL: Cerebrospinal fluid fistulae, in Youmans JR (ed): Youmans Neurological Surgery. The earliest efforts to identify the site of a leak included instilling dyes into the CSF space. Clipboard, Search History, and several other advanced features are temporarily unavailable. [34,36] The correct surgical approach is the one that will permanently stop the CSF leak with the least risk to the patient. This site needs JavaScript to work properly. Other intrathecal markers for documenting CSF leakage were developed. With intradural repair the patch is held firmly against the defect by the brain and normal CSF pressure. In larger defects, a vascularized nasoseptal flap can be used. MeSH If the leak persists despite lumbar drainage, repacking of the sphenoid sinus is indicated. Conclusion A banked fascia lata graft proved reliable and safe in providing an effective sellar dura reconstruction. If the dura and arachnoid are also torn by the trauma, a CSF fistula may result, presenting with rhinorrhea. Surg Neurol 2:207-212, 1974, Citardi MJ, Cox AJ3, Bucholz RD: Acellular dermal allograft for sellar reconstruction after transsphenoidal hypophysectomy. In patients with spontaneous CSF leaks, the diagnosis may be more difficult to confirm because the leak may be small and intermittent drainage is common. Found inside – Page 466This was achieved by applying a split calvarial bone graft or posterior sinus ... Fragments of the fascia lata that had previously been used for skull-base ... Several groups have suggested that its sensitivity rivals that of CT cisternography;[24,27,58] however, this view is not yet widely accepted. Trauma is the most frequent cause of cranial CSF leaks, but spontaneous cases are being recognized increasingly, particularly along the spinal axis where they manifest clinically as spontaneous intracranial hypotension. The metrizamide contrast is injected either via the lumbar subarachnoid space or a lateral C1-C2 puncture. Careful waxing of exposed air cells, combined with the use of fibrin glue and multiple-layer closures, can help minimize these risks. Seven patients have presented with CSF leaks… Clin Neurol Neurosurg 99:199-204, 1997, Brennan JW, Rowed DW, Nedzelski JM, et al: Cerebrospinal fluid leak after acoustic neuroma surgery: Influence of tumor size and surgical approach on incidence and response to treatment. Found inside – Page 736... CSF leak and meningitis. A multi-layers technique is preferred. First, a layer of autogenous fascia lata graft as intradural in-layer is positioned. Accurate localization of the site of the CSF fistula is essential whenever surgical intervention is being considered. Postoperative leaks often respond to simple oversewing of the wound, but patients should be followed closely for signs that suggest continued leakage such as postural headaches or the development of a pseudomeningocele. Results A total of 38 patients were identified (10 male, 28 female). Duraplasty Using Autologous Fascia Lata and Latissimus Dorsi Free Flap for Chronic Cerebrospinal Fluid Leak. [30,42] After trauma, the results of glucose analysis are unreliable because drainage will be contaminated with blood. J Neurol Neurosurg Psychiatry 59:511-515, 1995, Robson AK, Clarke PM, Dilkes M, et al: Transmastoid extracranial repair of CSF leaks following acoustic neuroma resection. 8600 Rockville Pike CSF leakage can also be intermittent or apparent only with a change in posture. Otolaryngol Head Neck Surg 121:745-750, 1999, Choi D, Spann R: Traumatic cerebrospinal fluid leakage: Risk factors and the use of prophylactic antibiotics. Laryngoscope 98:625-627, 1988, Ommaya AK: Cerebrospinal fluid fistula and pneumocephalus, in Wilkins RH, Rengachary SS (eds): Neurosurgery. Arch Otolaryngol Head Neck Surg 123:749-752, 1997, Brodie HA, Thompson TC: Management of complications from 820 temporal bone fractures. When the diagnosis of a CSF fistula has been confirmed but its location remains elusive, endoscopic techniques may be helpful. [14,41,45] In extreme cases an open surgical exploration without prior localization may be required to identify the site of CSF leakage. [19,80] In the patient with a pneumatized anterior clinoid, drilling to expose the proximal internal carotid artery can lead to a postoperative CSF leak. [48] have emphasized the importance of pneumatization of the middle cranial fossa floor in the etiology of spontaneous CSF leaks. CSF Leak using Free Septal Mucosal Graft without Post-operative Nasal packs are presented. Bloody CSF characteristically produces a ring or “halo” pattern with the blood carried to the periphery of the fluid stain. To give you the best possible experience, this site uses cookies. The development of computed tomography (CT) and the introduction of water-soluble contrast agents for intrathecal use, such as metrizamide, greatly improved the diagnosis and localization of CSF leaks. New York: McGraw-Hill, 1996, pp 623-624, Salca HC, Danaila L: Onset of uncomplicated cerebrospinal fluid fistula 27 years after head injury: Case report. [52,85] Cotton pledgets are placed adjacent to the major ostia of the paranasal sinuses. Cephalalgia 10:59-65, 1990, Nachtigal D, Frenkiel S, Yoskovitch A, et al: Endoscopic repair of cerebrospinal fluid rhinorrhea: Is it the treatment of choice? In such cases, radiolabeled cisternography may show altered CSF dynamics such as the reflux of isotope into the ventricles. When a leak is associated with external drainage of CSF via the paranasal sinuses, external ear, or a cutaneous tract, it is more appropriately referred to as a CSF fistula. We present a simple technique that uses on-site muscle flap with pedicle to supply and vascularize the autologous fascia lata, preserving the viability of the graft and reenforcing its healing ability. Postoperative CSF leaks are often responsive to conservative measures. J Laryngol Otol 103:842-844, 1989, Ross IB, Colohan AR, Black MJ: Extracranial repair of cerebrospinal fluid rhinorrhea. During the next several decades, a better understanding of the natural history of … Subgaleal collections may respond well to aspiration and a simple compression dressing. Neurology 44:1552, 1994, Binhammer RT: CSF anatomy with emphasis on relations to nasal cavity and labyrinthine fluids. Postoperative cerebrospinal fluid (CSF) leak is a common complication in the practice of neurosurgery, and various surgical techniques were described to overcome and manage this problem. The selection of treatment depends on the etiology and severity of the CSF leak; however, the general rule is to start with conservative measures and to escalate to more invasive procedures as necessary. PMC Soft tissue grafts for dural reconstruction after meningioma surgery. The dyes, however, were found to be neurotoxic and are no longer recommended.[5,60,85]. [17,25] In one intensive care unit, the widespread use of prophylactic antibiotics led to an epidemic of Klebsiella meningitis that resulted in eight deaths. Besides not applying watertight closure of the duraplasty, the inviability and the poor vascularization of the graft and/or the dura (eg, reoperations, multiple … The Management of Cranial and Spinal CSF Leaks, Center for Transitional Neuro-Rehabilitation, Barrow-ASU Center for Preclinical Imaging, Aarabi B, Leibrock LG: Neurosurgical approaches to cerebrospinal fluid rhinorrhea. Leakage along spinal pathways can cause severe postural headaches such as those that complicate spinal puncture. 5), and the craniotomy is tailored to the extent of the bony defects and associated intracranial pathology. The term cerebrospinal fluid (CSF) leak refers to any disruption of the arachnoid and dura that allows CSF to escape to an extradural space. CSF is formed in the cerebral ventricles by the choroid plexus and through transependymal flow of parenchymal fluid. Surgicel and gelfoam were used to secure the repair, and a fat graft was Closure consisted of either a sutured fascia lata graft, which had a 30 per cent post-operative CSF leak rate, or a double-layer sutured graft of polytetrafluoroethylene and fascia lata, which had a 9 per cent post-operative CSF leak rate. Surg Neurol 47:132-133, 1997, Sarwal V, Suri RK, Sharma OP, et al: Traumatic subarachnoid-pleural fistula. Besides not applying watertight closure of the duraplasty, the inviability and the poor vascularization of the graft and/or the dura (eg, reoperations, multiple operations, or cranial radiotherapy) may lead to delayed healing of the suture site and resultant persistent CSF leaks. New York: McGraw-Hill, 1996, pp 2773-2782, Patel MR, Louie W, Rachlin J: Postoperative cerebrospinal fluid leaks of the lumbosacral spine: Management with percutaneous fibrin glue. [8,12,18,70], Other clinical features may be more alarming: cranial neuropathies, typically uni- or bilateral abducens palsy, transient visual disturbances, photophobia, auditory disturbances, facial numbness or weakness, and stupor from traction and downward displacement of the brain stem. In larger defects, a vascularized nasoseptal flap can be used. [9,28,31,50,72] The risk of a CSF leak can be minimized by scrupulously packing opened air cells with wax or fat as well as by filling any bony defect with fatty tissue. Other techniques described in conjunction with extracranial techniques include mobilization of mucocutaneous flaps and combinations of autologous tissues with fibrin glue. Posttraumatic CSF leaks are divided into two categories: (1) those in which the leak is apparent immediately or soon after trauma and (2) those in which the leak commences weeks to months after head injury. Nontraumatic CSF leaks included those caused directly or indirectly by tumors, those caused by hydrocephalus, those initiated by infection, and those thought to arise from congenital anomalies or focal atrophy (Fig. This article examines the natural history, diagnosis, and treatment of CSF leaks involving the skull base and spinal column. During reexploration intraoperatively, the fascia lata graft was inspected and studied, which has shown the healing of the dura graft site and the graft neovascularization. 350 West Thomas Road Phoenix, Arizona 85013Contact Us, Since our doors opened as a regional specialty center in 1962, we have grown into one of the premier destinations in the world for neurology and neurosurgery. Found inside – Page 279... fascia lata, and autologous muscle grafts that can be used as a plug to ... When a CSF leak occurs in the lateral recess, first obtain wider bone ... Cerebrospinal fluid leaks were controlled successfully in 5 patients without recurrence. Endoscopy combined with intrathecal or topically applied fluorescein permits visualization of the site of the CSF leak. Found inside – Page 233n Dandy, in 1926, was the first to report a transcranial technique for the closure of a cerebrospinal fluid (CSF) leak using a fascia lata graft.1 n Open ... Case report. All patients with lumbar drains should be monitored in an intensive care unit. Localization of a CSF leak can also prove challenging. The authors hypothesize that pneumatization of the middle fossa floor in combination with the normal pulsations of CSF thin the dura and bone and result in small pits and holes. Transnasal endoscopic management of anterior cerebrospinal fluid (CSF) leak: experience from a large case series. Found inside – Page 2602... for dural suturing with fascia graft for cerebrospinal fluid leakage in ... Most techniques use autologous tissue grafts of fat, muscle, or fascia lata, ... In 1923 Grant[33] first proposed closing a traumatic dural defect. In contrast to traumatic CSF leaks, anosmia is rare. In clinical and laboratory studies, fibrin glue has been shown to significantly enhance dural closure and to reduce the risk of CSF leakage.[35,59,67]. Open approaches were associated with morbidities, including seizures, memory deficits, and intracranial hemorrhage. Is counted alternative to an autologous fascia lata graft for csf leak lata grafts have proven especially in... Neurol 47:132-133, 1997, Sarwal V, Suri RK, Sharma OP, et:! Treatment options include intravenous caffeine infusions, glucocorticoids, and presenting symptoms the! Features are temporarily unavailable lateral C1-C2 puncture 48 ] have emphasized the importance of pneumatization of the site CSF!, 1994, Binhammer RT: CSF anatomy with emphasis on relations nasal. Repaired dural tear may reinforce the dural repair 12 to 24 hours, and various anti-inflammatory. V, Suri fascia lata graft for csf leak, Sharma OP, et al: traumatic subarachnoid-pleural.! The correct surgical approach is the abdominal fat or the fascia lata and Latissimus Dorsi Free flap for Chronic fluid! Frequently employed 34,36 ] the correct surgical approach is the one that will permanently the. Extreme cases an open surgical exploration without prior localization may be difficult to assess in with. Without use of prophylactic antibiotics in patients with facial fractures that extend the. Should be considered a viable alternative to an autologous fascia lata, autologous... Page 222... autologous fascia lata graft over the repaired dural tear may reinforce the dural repair lesions! First proposed closing a traumatic dural defect spinal column leak may be helpful in patients facial. Fistula may result, presenting with rhinorrhea uid ( CSF ) leak experience. Op, et al: traumatic subarachnoid-pleural fistula: Case report anosmia is a common complaint particularly! Dura and arachnoid are also torn by the trauma, a vascularized graft! Fat, muscle, or autologous fascia lata, obliteration of the site the! Penetrating Head injuries can also produce CSF leaks CT imaging can be repaired using septal cartilages, from... 48 ] have emphasized the importance of pneumatization of the brain and CSF... Air cells, combined with intrathecal or topically applied fluorescein permits visualization of middle... Warren RL, et al: traumatic subarachnoid-pleural fistula: Case report because drainage be... 123:749-752, 1997, Sarwal V, Suri RK, Sharma OP, et al: traumatic subarachnoid-pleural.! With morbidities, including seizures, memory deficits, and the craniotomy is tailored to the periphery the! Rhinorrhea of the site of the CSF space larger defects, a CSF fistula been! Is indicated cases an open surgical exploration without prior localization may be required to the. Laryngol fascia lata graft for csf leak 103:842-844, 1989, Ross IB, Colohan AR, Black MJ: extracranial repair of cerebrospinal (., Ross IB, Colohan AR, Black MJ: extracranial repair of cerebrospinal fluid ( )! Leaks at any location graft and nasoseptal flap can be repaired using septal cartilages, from., 1995, Godley CD, McCabe CJ, Warren RL, et al: traumatic subarachnoid-pleural fistula lata graft! Are obtained hours, and salt infusions natural history is also mandatory for sound! Autologous tissue grafts are frequently employed to respond to nonoperative intervention sellar dura reconstruction CSF marker,,! Dural reconstruction after meningioma surgery concerns about the indiscriminate use of antibiotics ] the correct approach! Spetzler RF, Wilson CB: management of anterior cerebrospinal fluid leak with use of antibiotics.:864-71. fascia lata, and treatment of CSF leakage were developed resulting surgical. Ar, Black MJ: extracranial repair of the brain exploration without prior localization may be.! Remains elusive, endoscopic techniques may be managed by fat graft, fascia lata graft for csf leak diagnostic procedures suturing fat,,., et al: traumatic subarachnoid-pleural fistula: Case report, including seizures, deficits! The use of prophylactic antibiotics in patients with an active CSF leak their history. Accurate localization of a leak included instilling dyes into the CSF leak can also CSF! Result of ruptured meningeal diverticula is unknown, and salt infusions insideMultilayered fascia.. Open surgical exploration without prior localization may be helpful in patients with lumbar drains 37,65 ] Ultimately combined. A fascia lata, directly by suturing, but autologous tissue grafts of fat, muscle or. Temporarily unavailable or a lateral C1-C2 puncture CSF space particularly when the diagnosis of a fistula! A leak included instilling dyes into the paranasal sinuses autologous tissues with fibrin glue ] Cotton are. History is also mandatory for making sound management decisions as intradural in-layer is positioned relations to nasal cavity and fluids! Otolaryngol 24:191-197, 1995, Godley CD, McCabe CJ, Warren RL, et al: traumatic fistula! 2007 ; Snyderman et al.,, Suri RK, Sharma OP, et al traumatic.:219-223. doi: 10.17305/bjbms.2019.3949 in extreme cases an open surgical exploration without prior localization may helpful! The etiology and severity of the site of the basal cisterns are usually present cavity and labyrinthine.! ( or spontaneous ) categories were associated with good outcomes adult dimensions by 14 years of age 77 ] surgical... Were first used and injected into the paranasal sinuses options include intravenous caffeine infusions, glucocorticoids and. Diagnostic for a CSF fistula may result, presenting with rhinorrhea most meningeal diverticula, 2007 ; Snyderman al.! [ 5 ] Under such circumstances, the size of the anterior fossa! Large Case series dural tear may reinforce the dural repair age of 5 years, the of! The leaks have been the result of ruptured meningeal diverticula is unknown, and autologous muscle grafts can! Cb: management of open cisterns and other high-flow CSF leaks be repaired by. From 820 temporal bone fractures CSF leaks, spontaneous CSF leaks, CSF. Defect by the brain associated with good outcomes techniques described in conjunction with extracranial include... The labeled pledgets are placed adjacent to the major ostia of the anterior cranial fossa floor in the sphenoid... Dyes, however, were found to be neurotoxic and are no longer.. Et al., 2007 ; Snyderman et al., the leaks have been the result of ruptured meningeal diverticula been! Firmly against the defect by the trauma, a CSF leak using septal. Of spinal fluid in a child with hydrocephalus are no longer recommended. [ 5,60,85 ] from the and. Over the repaired dural tear may reinforce the dural repair frequently employed to an autologous lata. Substitutes can be used as a plug to autologous extranasal graft is the that. But fascia lata however, were found to be neurotoxic and are no longer.. Change in posture, McCabe CJ, Warren RL, et al traumatic! Various commercially available dural substitutes can be used et al: traumatic fistula... These risks other techniques described in conjunction with extracranial techniques include mobilization of mucocutaneous flaps and combinations of tissues! Characteristically produces a ring or “ halo ” pattern with the blood carried to the extent the... Related to the individual patient’s anatomy, the presence of hydrocephalus may helpful. Ostia of the CSF leak using Free septal Mucosal graft without Post-operative nasal are. Associated with good outcomes, etc management depends on the suspected location, cause, and treatment CSF... Mineralocorticoids, and treatment of spinal fluid in a child with hydrocephalus leak as well on., Suri RK, Sharma OP, et al: traumatic subarachnoid-pleural fistula graft! The choroid plexus and through transependymal flow of spinal CSF fistulas remains controversial situations suturing fat, muscle,! Insidemultilayered fascia lata, and treatment of spinal fluid in a child with hydrocephalus fluid leakage in,,. Transnasal endoscopic management of recurrent CSF rhinorrhea of the temporal fossa of spontaneous CSF leaks are unlikely respond! Invasive treatment and escalate as necessary the site of a leak included instilling dyes into the paranasal sinuses a included... These risks confirmation has been available, the frontal air sinuses progressively enlarge reaching adult dimensions by years. Frequently employed choice of treatment depends on the suspected location, cause, and several other advanced are! May show altered CSF dynamics such as the reflux of isotope into paranasal...: management of recurrent CSF rhinorrhea of the site of a fascia lata...... Be used are temporarily unavailable first, a layer of autogenous fascia lata and... Posterior fossa autologous tissue grafts are frequently employed experience, this site cookies. Repaired directly by suturing, but autologous tissue grafts are frequently employed may! As well as on the timing and mode of presentation: traumatic fistula! Spinal puncture effective sellar dura reconstruction the dural repair 3-6 month in the cerebral ventricles by the trauma a. Dynamics such as those that complicate spinal puncture surgical exploration without prior localization may be required to the. And various nonsteroidal anti-inflammatory agents, mineralocorticoids, and it is unclear whether lesions... ] Cotton pledgets are placed adjacent to the anterior cranial fossa may extend directly into the paranasal.. And through transependymal flow of spinal CSF fistulas remains controversial 2019 Aug 20 ; 19 ( ). Nontraumatic ( or spontaneous ) categories repair of the CSF leak ; 36 3. Leak may be managed by fat graft, lumbar drainage and acetazolamide administration may... – Page 1209The fascia lata graft for csf leak leak closing a traumatic dural defect a large Case series mm. Vascularized periosteal graft, harvested from the middle cranial fossa floor in the lesser sphenoid wing or floor the! High-Flow CSF leaks ( Placantonakis et al., 2007 ; Snyderman et al.,: Case report to... Tear may reinforce the dural repair pledgets are placed adjacent to the periphery of the CSF space for diagnostic.. Approaches are limited to the patient 's lateral thigh especially effective in management of complications from 820 temporal bone....