CSF Leaks Article

http://www.utmb.edu/otoref/grnds/CSF-leaks-050112/CSF-leaks-050112.htm

Excerpts from another very good article.

"Cerebrospinal fluid (CSF) leaks are composed of CSF rhinorrhea or otorrhea, which implies an abnormal communication between the subarachnoid space and the nasal cavity or tympanomastoid space.  CSF leaks may present in a number of ways, including middle ear effusion, hearing loss, or unilateral rhinorrhea secondary to Eustachian tube drainage.  Therefore, the otolaryngologist must keep a high clinical suspicion.  The diagnosis must be either confirmed or excluded as the risk of meningitis is high, with reported rates varying between 2-88%.  The clinician must be aware of the diagnostic and treatment options available in order to best manage such patients."

"With transverse fractures, the tympanic membrane is typically intact and the fluid may build within the middle ear and mastoid and eventually drain thought the eustachian tube producing CSF rhinorrhea."

"Surgical repair is recommended for those cases that do not resolve in order to prevent the morbidity and mortality associated with meningitis.  Tegmen defects may be multiple rather than single, and identifying only one defect may not be sufficient for achieving definitive repair.  Because surgical repair by way of a mastoidectomy approach alone can be inadequate if there are multiple tegmen defects, a middle fossa approach alone or in combination with a transmastoid approach should be considered in most cases."

"The success rate is significantly higher for those patients who undergo primary closure with a multi-layer technique (using bone wax plus 2 additional materials, such as Oxycel cotton, muscle, fascia, or abdominal fat) versus those patients who underwent primary closure with a single-layer technique.  The surgeon should also be prepared to deal with an encephalocele encountered incidentally during surgery.  This herniated, pedunculated tissue is functionless and can be amputated."

"The successful management of a patient with a history suggestive of a CSF leak involves ensuring that it is a true leak by testing the fluid for beta-2-transferrin.  Imaging studies should be performed in order to anatomically localize the site.  Surgery, if necessary, should minimize morbidity while maximizing the chances of a successful outcome.  This may be achieved by meticulous preoperative assessment and meticulous intraoperative techniques.  Success rates of over 90% can be expected with proper patient and surgical selection."