ABSTRACT
Cerebrospinal fluid (CSF) leaks are a relatively rare clinical manifestation for neurosurgical patients. Cranial CSF leaks are most commonly caused by head trauma, especially basilar skull fracture. Persistence of CSF leaks may lead to multiple complications, thereby significantly increasing patient morbidity and possibly mortality. CSF leaks may result in meningitis, pseudomeningocele formation, intracranial hypotension, neural element herniation, cranial nerve compression, fistula formation, and wound infection. The pressure within the subarachnoid space exceeds that of nearby tissues, thereby causing CSF to drain into surrounding tissues when there is a defect in the dura. Persistent CSF leaks are associated with significant morbidity and neurologic deficit and therefore must be treated aggressively. Initial management includes proper patient positioning. In intracranial leaks, the patient should have his or her head elevated from 40° to 75°. An important factor in achieving favorable outcomes following CSF drainage is early detection of the CSF leak, and early catheter placement.
