Commentary “Does Meningitis Stop CSF Rhinorrhea following Lateral Skull Base Surgery?”

In this brief report, Malik et al challenge the long-standing myth that the inflammatory response seen in meningitis helps to seal postoperative cerebrospinal (CSF) fistulae. The authors have retrospectively examined a highly select cohort of patients who developed postoperative CSF leaks and subsequently meningitis (seven patients) after surgery for acoustic neuromas. They conclude that the inflammation seen in meningitis is insufficient to seal such leaks and that other interventions (i.e., CSF diversion, operative repair) should not be withheld expectantly. We agree with their findings. The dural defect created during transpetrosal approaches is too large to be sealed by this inflammatory response. One cannot overstate the point that a postsurgical CSF leak requires urgent surgical intervention for closure. This may not hold true for all CSF fistulae, such as those encountered in skull base trauma. In patients with post-traumatic CSF leak, the defect is often small and may seal with this inflammatory response.[1]

REFERENCE

• 1 Eljamel M S, Foy P M. Acute traumatic CSF fistulae: the risk of intracranial infection.  Br J Neurosurg. 1990;  4 381-385