Prevention and Management of CSF Leakage Postoperatively

All skull-base surgeons are well aware of the risk of postoperative cerebrospinal fluid (CSF) leaks. It is understood that incising the dura to access the cerebellopontine angle (CPA) will provide a path for CSF to flow from the high intracranial pressure (ICP) region to the low-pressure regions of the temporal bone. Complicating this pressure differential is evidence that suggests CSF pressure significantly increases following vestibular schwannoma (VS) surgery, normalizing within 48 h of surgery [1]. Furthermore, with the presence of a CSF leak, patients risk developing an intracranial infection. Allen and colleagues identified that 3.1% of all their lateral skull-base surgery patients developed postoperative meningitis, calculating that a CSF leak increases a patient’s risk of developing meningitis by a factor of 10.2 [2]. Other groups have reported that untreated CSF leaks develop meningitis between 8% and 35% [3].