Skip to main content
SpringerLink
Log in

Conservative Management of CSF Leak

  • Chapter
  • First Online:
CSF Rhinorrhea

  • 435 Accesses

Abstract

Cerebrospinal fluid (CSF) rhinorrhea may be classified as traumatic and nontraumatic. The clinical presentation of CSF rhinorrhea includes unilateral watery drainage with a characteristic metallic or salty taste, often in the clinical setting of possible etiologic factors. Conservative treatment is recommended in cases of CSF leaks due to nonsurgical head trauma, while operative repair is preferred in those cases in which these conservative measures fail or in which massive injury requires urgent operative repair. Endoscopic endonasal repair has emerged as the gold standard modality for most cases of CSF rhinorrhea requiring surgical intervention.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 99.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 129.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 199.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Mirza S, Thaper A, McClelland L, Jones NS. Sinonasal cerebrospinal fluid leaks: management of 97 patients over 10 years. Laryngoscope. 2005;115(10):1774–7.

    Article  PubMed  CAS  Google Scholar 

  2. Alobid I, Enseñat J, Rioja E, Enriquez K, Viscovich L, de Notaris M, et al. Management of cerebrospinal fluid leaks according to size. Our experience. Acta Otorrinolaringol Esp. 2014;65(3):162–9.

    Article  PubMed  Google Scholar 

  3. DeConde AS, Suh JD, Ramakrishnan VR. Treatment of cerebrospinal fluid rhinorrhea. Curr Opin Otolaryngol Head Neck Surg. 2015;23(1):59–64.

    Article  PubMed  Google Scholar 

  4. Banks CA, Palmer JN, Chiu AG, O’Malley BW, Woodworth BA, Kennedy DW. Endoscopic closure of CSF rhinorrhea: 193 cases over 21 years. Otolaryngol Head Neck Surg. 2009;140(6):826–33.

    Article  PubMed  Google Scholar 

  5. Prosser JD, Vender JR, Solares CA. Traumatic cerebrospinal fluid leaks. Otolaryngol Clin N Am. 2011;44(4):857–73.

    Article  Google Scholar 

  6. Phang SY, Whitehouse K, Lee L, Khalil H, McArdle P, Whitfield PC. Management of CSF leak in base of skull fractures in adults. Br J Neurosurg. 2016;30(6):596–604.

    Article  PubMed  Google Scholar 

  7. Oakley GM, Alt JA, Schlosser RJ, Harvey RJ, Orlandi RR. Diagnosis of cerebrospinal fluid rhinorrhea: an evidence-based review with recommendations. Int Forum Allergy Rhinol. 2016;6(1):8–16.

    Article  PubMed  Google Scholar 

  8. Woodworth BA, Prince A, Chiu AG, Cohen NA, Schlosser RJ, Bolger WE, et al. Spontaneous CSF leaks: a paradigm for definitive repair and management of intracranial hypertension. Otolaryngol Head Neck Surg. 2008;138(6):715–20.

    Article  PubMed  Google Scholar 

  9. Oh J-W, Kim S-H, Whang K. Traumatic cerebrospinal fluid leak: diagnosis and management. Korean J Neurotrauma. 2017;13(2):63–7.

    Article  PubMed  PubMed Central  Google Scholar 

  10. Albu S, Florian IS, Bolboaca SD. The benefit of early lumbar drain insertion in reducing the length of CSF leak in traumatic rhinorrhea. Clin Neurol Neurosurg. 2016;142:43–7.

    Article  PubMed  Google Scholar 

  11. Bell RB, Dierks EJ, Homer L, Potter BE. Management of cerebrospinal fluid leak associated with craniomaxillofacial trauma. J Oral Maxillofac Surg. 2004;62(6):676–84.

    Article  PubMed  Google Scholar 

  12. Yilmazlar S, Arslan E, Kocaeli H, Dogan S, Aksoy K, Korfali E, et al. Cerebrospinal fluid leakage complicating skull base fractures: analysis of 81 cases. Neurosurg Rev. 2006;29(1):64–71.

    Article  PubMed  Google Scholar 

  13. Rimmer J, Belk C, Lund VJ, Swift A, White P. Immunisations and antibiotics in patients with anterior skull base cerebrospinal fluid leaks. J Laryngol Otol. 2014;128(7):626–9.

    Article  PubMed  CAS  Google Scholar 

  14. Ratilal BO, Costa J, Pappamikail L, Sampaio C. Antibiotic prophylaxis for preventing meningitis in patients with basilar skull fractures. Cochrane Database Syst Rev. 2015;(4):CD004884.

    Google Scholar 

  15. Uldall M, Botfield H, Jansen-Olesen I, Sinclair A, Jensen R. Acetazolamide lowers intracranial pressure and modulates the cerebrospinal fluid secretion pathway in healthy rats. Neurosci Lett. 2017;03(645):33–9.

    Article  Google Scholar 

  16. Tilak AM, Koehn H, Mattos J, Payne SC. Preoperative management of spontaneous cerebrospinal fluid rhinorrhea with acetazolamide: acetazolamide for spontaneous CSF leaks. Int Forum Allergy Rhinol. 2019;9(3):265–9.

    Article  PubMed  Google Scholar 

  17. Schlosser RJ, Wilensky EM, Grady MS, Palmer JN, Kennedy DW, Bolger WE. Cerebrospinal fluid pressure monitoring after repair of cerebrospinal fluid leaks. Otolaryngol Head Neck Surg. 2004;130(4):443–8.

    Article  PubMed  Google Scholar 

  18. Schlosser RJ, Bolger WE. Nasal cerebrospinal fluid leaks: critical review and surgical considerations. Laryngoscope. 2004;114(2):255–65.

    Article  PubMed  Google Scholar 

  19. Saito H, Ogasawara K, Suzuki T, Kuroda H, Kobayashi M, Yoshida K, et al. Adverse effects of intravenous acetazolamide administration for evaluation of cerebrovascular reactivity using brain perfusion single-photon emission computed tomography in patients with major cerebral artery steno-occlusive diseases. Neurol Med Chir (Tokyo). 2011;51(7):479–83.

    Article  Google Scholar 

  20. Pepper J-P, Lin EM, Sullivan SE, Marentette LJ. Perioperative lumbar drain placement: an independent predictor of tension pneumocephalus and intracranial complications following anterior skull base surgery. Laryngoscope. 2011;121(3):468–73.

    Article  PubMed  Google Scholar 

  21. Tuettenberg J, Czabanka M, Horn P, Woitzik J, Barth M, Thomé C, et al. Clinical evaluation of the safety and efficacy of lumbar cerebrospinal fluid drainage for the treatment of refractory increased intracranial pressure. J Neurosurg. 2009;110(6):1200–8.

    Article  PubMed  Google Scholar 

  22. Daudia A, Biswas D, Jones NS. Risk of meningitis with cerebrospinal fluid rhinorrhea. Ann Otol Rhinol Laryngol. 2007;116(12):902–5.

    Article  PubMed  Google Scholar 

  23. Bernal-Sprekelsen M, Bleda-Vázquez C, Carrau RL. Ascending meningitis secondary to traumatic cerebrospinal fluid leaks. Am J Rhinol. 2000;14(4):257–9.

    Article  PubMed  CAS  Google Scholar 

  24. Brodie HA. Prophylactic antibiotics for posttraumatic cerebrospinal fluid fistulae. A meta-analysis. Arch Otolaryngol Head Neck Surg. 1997;123(7):749–52.

    Article  PubMed  CAS  Google Scholar 

  25. Centers for Disease Control and Prevention (CDC). Use of 13-valent pneumococcal conjugate vaccine and 23-valent pneumococcal polysaccharide vaccine among children aged 6-18 years with immunocompromising conditions: recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR Morb Mortal Wkly Rep. 2013;62(25):521–4.

    Google Scholar 

  26. Centers for Disease Control and Prevention (CDC). Use of 13-valent pneumococcal conjugate vaccine and 23-valent pneumococcal polysaccharide vaccine for adults with immunocompromising conditions: recommendations of the advisory committee on immunization practices (ACIP). MMWR Morb Mortal Wkly Rep. 2012;61(40):816–9.

    Google Scholar 

  27. Eljamel MS, Foy PM. Acute traumatic CSF fistulae: the risk of intracranial infection. Br J Neurosurg. 1990;4(5):381–5.

    Article  PubMed  CAS  Google Scholar 

  28. Bernal-Sprekelsen M, Alobid I, Mullol J, Trobat F, Tomás-Barberán M. Closure of cerebrospinal fluid leaks prevents ascending bacterial meningitis. Rhinology. 2005;43(4):277–81.

    PubMed  Google Scholar 

  29. Schick B, Weber R, Kahle G, Draf W, Lackmann GM. Late manifestations of traumatic lesions of the anterior skull base. Skull Base Surg. 1997;7(2):77–83.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  30. Tohge R, Takahashi M. Cerebrospinal fluid rhinorrhea and subsequent bacterial meningitis due to an atypical clival fracture. Intern Med. 2017;56(14):1911–4.

    Article  PubMed  PubMed Central  Google Scholar 

  31. Thorp BD, Sreenath SB, Ebert CS, Zanation AM. Endoscopic skull base reconstruction: a review and clinical case series of 152 vascularized flaps used for surgical skull base defects in the setting of intraoperative cerebrospinal fluid leak. Neurosurg Focus. 2014;37(4):E4.

    Article  PubMed  Google Scholar 

  32. Archer JB, Sun H, Bonney PA, Zhao YD, Hiebert JC, Sanclement JA, et al. Extensive traumatic anterior skull base fractures with cerebrospinal fluid leak: classification and repair techniques using combined vascularized tissue flaps. J Neurosurg. 2016;124(3):647–56.

    Article  PubMed  Google Scholar 

  33. Hadad G, Bassagasteguy L, Carrau RL, Mataza JC, Kassam A, Snyderman CH, et al. A novel reconstructive technique after endoscopic expanded endonasal approaches: vascular pedicle nasoseptal flap. Laryngoscope. 2006;116(10):1882–6.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Surgery, The University of Auckland, Auckland, New Zealand

    Camila Dassi & Richard Douglas

  2. University of Valencia Medical School, Valencia, Spain

    Manuel Bernal-Sprekelsen

Authors
  1. Camila Dassi
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Manuel Bernal-Sprekelsen
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Richard Douglas
    View author publications

    You can also search for this author in PubMed Google Scholar

Editor information

Editors and Affiliations

  1. Department of Otorhinolaryngology, King Fahd Medical City, Riyadh, Saudi Arabia

    Abdulaziz A. AlQahtani

  2. Department of Otorhinolaryngology, University of Insubria, Varese, Varese, Italy

    Paolo Castelnuovo

  3. Department of Otolaryngology, Head and Neck Surgery, University of Miami, Miller School of Medicine, Miami, FL, USA

    Roy Casiano

  4. Department of Otolaryngology-Head and Neck Surgery, The Ohio State University Wexner Medical Center, Columbus, OH, USA

    Ricardo L. Carrau

Rights and permissions

Reprints and permissions

Copyright information

© 2022 Springer Nature Switzerland AG

About this chapter

Check for updates. Verify currency and authenticity via CrossMark

Cite this chapter

Dassi, C., Bernal-Sprekelsen, M., Douglas, R. (2022). Conservative Management of CSF Leak. In: AlQahtani, A.A., Castelnuovo, P., Casiano, R., Carrau, R.L. (eds) CSF Rhinorrhea. Springer, Cham. https://doi.org/10.1007/978-3-030-94781-1_9

Download citation

  • DOI: https://doi.org/10.1007/978-3-030-94781-1_9

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-030-94780-4

  • Online ISBN: 978-3-030-94781-1

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation