Background: CSF leaks have been historically difficult to diagnose and treat as their etiology
can widely vary. There are currently insufficient diagnostic predictors and no clinically
accepted standards for their treatment.
Objective: This large institutional study reports on the diagnosis, management, and outcomes
of patients presenting with CSF leak over 10 years and aims to identify potential
comorbidities and risk factors for primary and recurrent leaks.
Methods: Patients diagnosed with CSF leak from 2007 to 2017 were analyzed retrospectively.
The data included past medical history, BMI, surgical treatment, and postoperative
outcomes.
Results: A total of 116 cases were identified. The location of leaks was 90 CSF rhinorrhea
and 29 CSF otorrhea. The average BMI for females was greater than males (p = 0.01). The etiology of the leaks was 65 noniatrogenic, 45 iatrogenic, and 9 traumatic.
108 cases resulted in surgical treatment. 69 involved endoscopic approaches, 42 involved
open approaches, and 83 involved the placement of a lumbar drain. 18 cases had a VP
shunt and 6 had a LP shunt. 78 (72.22%) cases had an associated encephalocele with
the CSF leak. The average length of stay was 7.73 (0.76) days. The average length
of follow-up was 1.58 (0.22) years. The primary repair rate was 80.17% (n = 93) and the overall repair outcome was 99.14% (n = 115).
Conclusion: The overall CSF repair outcome was 99.14% over 10 years at a single institution.
Despite this high percentage, CSF leaks continue to be a complex problem and require
vigorous multidisciplinary work with close follow-up and use of multiple imaging strategies.
