No way for spontaneous CSF leak to stop

1. spontaneous CSF
Leakage -Myth of
Stoppage
Dr. Saied Alhabash
ENT Dep. Damascus
University
Medcare Sharja Hospital

4. CSF leak
Traumatic
Accident Iatrogenic
Non traumatic
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5. Non traumatic
High pressure
TUMOR
HYDROCEPHALUS
Normal pressure
OSTEOMYELITIC
ERROSION
FOCAL ATROPHY
CONGENITAL
ANOMALIES
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6. Traumatic Non traumatic
Incidence 2% of head injury Rare
Age Irrespective Adult , middle age
Sex Irrespective Female 2 : 1 male
Onset Acute ( within 48 hours ) Insidious
Duration 1 week 70% Years
Amount of leakage Few drops Profuse
Laterality Unilateral ( usually) Variable
Aerocele 20% Unusually
Anosmia 80% Rare
Head ache Uncommon Common
Risk of infection High 25-50% Low
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12. Diagnosis
1-identification of CSF by
1. CSF is clear like water
2. not excoriate the nose
3.salty taste
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13. • Biochemical tests :
– sugar more than 30 mg/ dl , false positive 60% present , negative test
very useful to exclude csf ,
– beta 2 transferrin
– trace protein( more sensitive )
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14. 2. Site of fistula localization
A. CT Scan to rule out hydrocephlaus and neoplasm , non
contrast CT for bony abnormality ,contrast CT to identify
leaking site associated with adjacent abnormal brain
paranchyma
B. Water soluble contrast CT cisternography ( ws-ctc) used when
site of leak not localized by CT , multiple bony defect to
identify active leaking site
C. MRI : T2 prone position :
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17. Primary Spontaneous Cerebrospinal Fluid Leaks and
Idiopathic Intracranial Hypertension
Mario A. Pérez, MD, Omer Y. Bialer, MD, Beau B. Bruce, MD, MS, Nancy J. Newman, MD, and Valérie Biousse, MD
CSF leak may occasionally keep IIH patients symptom-free;
however, classic symptoms and signs of intracranial hypertension
may develop after the CSF leak is repaired, exposing these
patients to a high risk of recurrence of the leak unless an ICP-
lowering intervention is performed.
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18. • The strong association between IIH and spontaneous CSF leaks
in the literature, reinforced by our cases, supports systematic
screening for symptoms and signs of increased ICP within
weeks after surgical repair of a presumed spontaneous CSF
leak. Early identification of these patients is warranted to
prevent failure of the CSF leak repair, and to prevent visual loss
from papilledema. Additionally, IIH patients with chronically
raised ICP likely warrant strict follow up for the development of
a CSF leak
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19. • 10 cases of spontaneous CSF leak were followed here after csf
leak closure.
• 3 of them needed shunt, one of them after 1 month directly
• Strict follow up is mandatory even if the closure happened
after meningitis
• Meningeoceles have the same concept exactly
• Underlay technique is very tight- Sometimes it is better to
recure that3/28/2018 19

20. Take Home Meesage
• No spontaneous CSF leak might close spontaneously- Do not
make this risk, No need to try Diamox or others.
• Doing shunt before closing is a big mistake because it will be
difficult to trace it then.
• Golden rule : Ig the patient did not drip in your leak, it is rarely
to be CSF.Do not trust the patient too much.
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S02.2XXA

21. • Thanks
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