ABSTRACT
Prompt primary repair of dural tears is crucial to prevent the complications of a persistent dural tear, including persistent cerebrospinal fluid (CSF) fistula or formation of a pseudocyst, which places patients at risk of meningitis. Magnetic resonance imaging is used to investigate for evidence of a persistent CSF leak in the postoperative setting. Investigation strategies used to confirm that any fluid draining is CSF includes using reagent urinary destrostix strips to assess for the presence of dextrose, or using electrophoresis to assess for beta-2 transferrin. Subarachnoid drainage is an option for irreparable durotomies, CSF fistulas, and pseudomenigoceles and function by diversion of CSF from the defect while decreasing the pressure gradient between the intradura and extradural space. Pseudomeningocele and myelocutaneous fistula are possible sequelae of a missed dural tear or persistent CSF leak, and they can have significant functional and cosmetic implications.
