Treatment strategies differ according to the underlying etiology and leak location but surgical repair is often needed. The latter reported spontaneous fistulae to be the most commonly reported type, accounting for 41.1% of fistulae. who found an almost identical distribution amongst traumatic (50.2%) vs. found traumatic causes to be more common (61%), as opposed to Psaltis, et al. Congenital and tumor-based leaks are beyond the range of this review, and will therefore not be discussed. Differentiation is often made between traumatic (either iatrogenic or non-iatrogenic) and non-traumatic (spontaneous, congenital and tumor-based) causes. Future studies, preferably large multicenter randomized controlled trials (RCTs), are warranted to confirm this clinical observation.Īcetazolamide, Cerebrospinal fluid leak, Endonasal endoscopic closure, Idiopathic intracranial hypertensionĬerebrospinal fluid (CSF) rhinorrhea results from communication between the subarachnoid space and sinonasal cavity. Regular administration in the postoperative care of spontaneous CSF leak closures might be considered to increase success rates. She experienced no signs nor symptoms of elevated ICP.Īcetazolamide is widely accepted as first line treatment in IIH and is sometimes used postoperatively after endoscopic closure of spontaneous CSF leaks associated with elevated ICP. Our third patient had an empty sella on preoperative imaging, a finding often associated with IIH, and therefore was given acetazolamide immediately postoperative. Still, acetazolamide was administered after which their symptoms subsided. However, further examination was within normal ranges. Postoperatively, two patients experienced headaches resembling those accompanying elevated ICP. We retrospectively reviewed the charts of three patients at our center who were surgically treated for spontaneous CSF leaks.
#Spontaneous cerebrospinal fluid leak specialist update#
We aim to give an update about the current use of acetazolamide in the postoperative care of spontaneous CSF leak closure. There is growing evidence that active intracranial pressure (ICP) management in the postoperative care can improve success rates.
Spontaneous CSF leak closure often requires surgery, which has proven to be less successful than their non-spontaneous counterparts. This is thought to be a variant of idiopathic intracranial hypertension (IIH). Spontaneous cerebrospinal fluid (CSF) leaks are defined as leaks without identifiable etiology, often presenting as spontaneous rhinorrhea.
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