Objective: Cerebrospinal fluid (CSF) leaks can occur after head trauma or skull base surgery.
Persistent or spontaneous leaks should be repaired, since they put patients at risk
for serious intracranial complications. Although numerous repair methods have been
successful, the occasional patient develops a persistent leak. We describe our experience
with free tissue transfer for repair of recalcitrant CSF leaks.
Study Design: Retrospective chart review of patients undergoing free tissue transfer for repair
of a CSF leak between November 1995 and October 2004. Setting was an academic, tertiary
care referral center.
Methods: Twelve patients with persistent CSF leak were studied. Eleven of 12 patients had
undergone a previous repair attempt ranging from endoscopic repair with fat graft
to craniotomy and primary repair of the dural defect. All patients underwent radial
forearm free tissue transfer.
Results: There were six female and six male patients. Average age was 52.7 years (range, 22-80
y). The most common presenting complaints were intracranial abscess, recurrent meningitis,
or pneumocephalus (n = 9) and CSF otorrhea or rhinorrhea (n = 8). Cause was head trauma
(n = 6), prior surgery (n = 4), cholesteatoma (n = 1), or meningoencephalocele (n
= 1). Eleven of 12 patients failed prior procedures (range, 0-6 procedures; mean,
1.9). Ten flaps were placed in the anterior skull base and two were in the middle
or posterior skull base. Radial forearm free tissue transfer resulted in sustained
resolution of CSF leakage in all 12 patients.
Conclusions: Free tissue transfer is an efficacious option in the repair of recalcitrant CSF leaks
