Cranial and Spinal Cerebrospinal Fluid Leaks: Foundations of Identification and Management

• Published in: World neurosurgery 2024-07, Vol.187, p.288-293
• Main Authors: Chae, John K., Rosen, Kate, Zappi, Kyle, Giantini-Larsen, Alexandra, Yan, Jenny, Sung, Jeffrey, Bander, Evan, Schwartz, Theodore H., Park, John K., Salama, Gayle
• Format: Article
• Language: English
• Subjects: Cerebrospinal fluid leak; Cerebrospinal Fluid Leak - diagnosis; Cerebrospinal Fluid Leak - diagnostic imaging; Cerebrospinal Fluid Leak - surgery; Cerebrospinal Fluid Leak - therapy; CSF-venous fistula; Humans; Neurosurgical Procedures - methods; Orthostatic headache; Positional headache; Skull Base - diagnostic imaging; Skull Base - surgery; Skull base leak; Spontaneous intracranial hypotension
• ISSN: 1878-8750; 1878-8769; 1878-8769
• DOI: 10.1016/j.wneu.2024.03.111

Cerebrospinal fluid (CSF) leaks may occur at the skull base or along the spinal column and can cause a variety of debilitating neurological symptoms for patients. Recognizing the potential presence of a CSF leak and then identifying its source are necessary for accurate diagnosis and definitive treatment. A standardized workflow can be followed for successful leak localization, which often requires several diagnostic studies, and for definitive leak treatment, which can range from minimally invasive, needle-based approaches to a variety of surgical corrections. This review paper provides an overview of epidemiology, pathophysiology, and diagnostic workup for CSF leaks and introduces available treatment options. An illustrative case of a skull base CSF leak demonstrating diagnosis and surgical correction is provided.