Management of postoperative cerebrospinalfluid leak in transcranial surgeries Systematic review

Abstract

CSF leak isa well-known and frequent complication of intracranial procedures since the mid-20th century, Dandy first described CSF leak as a complication after suboccipital craniotomy for the removal of a vestibular schwannoma. CSF leakage is often a problem following surgery of the skull base, and craniotomies where the dura must be opened. Major series of craniofacial resections have CSF leak rates from 3 to 20% with a mean of between 8% and 10%. Factors that may influence the risk of CSF leakage include the method of dural repair, the presence of increased intracranial pressure, a history of prior radiation therapy, and the type of wound closure. The histology of a tumor, size, and location of the craniotomies are less likely to impact the incidence of postoperative CSF leakage. Numerous studies have focused on the clinical aspects of this challenging complication. Water tight dural closure is often not possible for various reasons. Therefore, numerous techniques and materials have been developed to obtain the perfect closure, which should result in the reduction of CSF leaks. CSF fistula was defined as wound collection, otorrhea, wound leakage, or rhinorrhea. It leads to increased morbidity, prolongation of hospital stay, surgical revision, and enhanced costs as well as possible surgical revisions.