J Neurol Surg B Skull Base 2016; 77(05): 404-411
DOI: 10.1055/s-0036-1584229
Review Article
Georg Thieme Verlag KG Stuttgart · New York

Management of Anterior Skull Base Cerebrospinal Fluid Leaks

Christopher Le
1   Department of Otolaryngology, University of California, Davis, Sacramento, California, United States
,
E. Bradley Strong
1   Department of Otolaryngology, University of California, Davis, Sacramento, California, United States
,
Quang Luu
1   Department of Otolaryngology, University of California, Davis, Sacramento, California, United States
› Author Affiliations
Further Information

Publication History

Publication Date:
02 June 2016 (online)

Abstract

Cerebrospinal fluid (CSF) leak occurs from traumatic, iatrogenic, and idiopathic etiologies. Its timely diagnosis requires clinical, radiographic, and laboratory testing. Medical and surgical management can mitigate the risk of life-threatening infection and morbidity. This article outlines the pathophysiology, diagnosis, and management or CSF leak of the anterior skull base.

 
  • References

  • 1 Han CY, Backous DD. Basic principles of cerebrospinal fluid metabolism and intracranial pressure homeostasis. Otolaryngol Clin North Am 2005; 38 (4) 569-576
  • 2 Yilmazlar S, Arslan E, Kocaeli H , et al. Cerebrospinal fluid leakage complicating skull base fractures: analysis of 81 cases. Neurosurg Rev 2006; 29 (1) 64-71
  • 3 Raveh J, Laedrach K, Vuillemin T, Zingg M. Management of combined frontonaso-orbital/skull base fractures and telecanthus in 355 cases. Arch Otolaryngol Head Neck Surg 1992; 118 (6) 605-614
  • 4 Scholsem M, Scholtes F, Collignon F , et al. Surgical management of anterior cranial base fractures with cerebrospinal fluid fistulae: a single-institution experience. Neurosurgery 2008; 62 (2) 463-469 , discussion 469–471
  • 5 Banks CA, Palmer JN, Chiu AG, O'Malley Jr BW, Woodworth BA, Kennedy DW. Endoscopic closure of CSF rhinorrhea: 193 cases over 21 years. Otolaryngol Head Neck Surg 2009; 140 (6) 826-833
  • 6 Kerr JT, Chu FW, Bayles SW. Cerebrospinal fluid rhinorrhea: diagnosis and management. Otolaryngol Clin North Am 2005; 38 (4) 597-611
  • 7 Ziu M, Savage JG, Jimenez DF. Diagnosis and treatment of cerebrospinal fluid rhinorrhea following accidental traumatic anterior skull base fractures. Neurosurg Focus 2012; 32 (6) E3
  • 8 Sherif C, Di Ieva A, Gibson D , et al. A management algorithm for cerebrospinal fluid leak associated with anterior skull base fractures: detailed clinical and radiological follow-up. Neurosurg Rev 2012; 35 (2) 227-237 , discussion 237–238
  • 9 Cukurova I, Cetinkaya EA, Aslan IB, Ozkul D. Endonasal endoscopic repair of ethmoid roof cerebrospinal fluid fistula by suturing the dura. Acta Neurochir (Wien) 2008; 150 (9) 897-900 , discussion 900
  • 10 Meurman OH, Irjala K, Suonpää J, Laurent B. A new method for the identification of cerebrospinal fluid leakage. Acta Otolaryngol 1979; 87 (3–4) 366-369
  • 11 Warnecke A, Averbeck T, Wurster U, Harmening M, Lenarz T, Stöver T. Diagnostic relevance of beta2-transferrin for the detection of cerebrospinal fluid fistulas. Arch Otolaryngol Head Neck Surg 2004; 130 (10) 1178-1184
  • 12 Meco C, Oberascher G, Arrer E, Moser G, Albegger K. Beta-trace protein test: new guidelines for the reliable diagnosis of cerebrospinal fluid fistula. Otolaryngol Head Neck Surg 2003; 129 (5) 508-517
  • 13 Zeng Q, Xiong L, Jinkins JR, Fan Z, Liu Z. Intrathecal gadolinium-enhanced MR myelography and cisternography: a pilot study in human patients. AJR Am J Roentgenol 1999; 173 (4) 1109-1115
  • 14 Zapalac JS, Marple BF, Schwade ND. Skull base cerebrospinal fluid fistulas: a comprehensive diagnostic algorithm. Otolaryngol Head Neck Surg 2002; 126 (6) 669-676
  • 15 Eljamel MS, Pidgeon CN, Toland J, Phillips JB, O'Dwyer AA. MRI cisternography, and the localization of CSF fistulae. Br J Neurosurg 1994; 8 (4) 433-437
  • 16 Schlosser RJ, Bolger WE. Nasal cerebrospinal fluid leaks: critical review and surgical considerations. Laryngoscope 2004; 114 (2) 255-265
  • 17 Lund VJ, Savy L, Lloyd G, Howard D. Optimum imaging and diagnosis of cerebrospinal fluid rhinorrhoea. J Laryngol Otol 2000; 114 (12) 988-992
  • 18 Muñoz A, Hinojosa J, Esparza J. Cisternography and ventriculography gadopentate dimeglumine-enhanced MR imaging in pediatric patients: preliminary report. AJNR Am J Neuroradiol 2007; 28 (5) 889-894
  • 19 Stone JA, Castillo M, Neelon B, Mukherji SK. Evaluation of CSF leaks: high-resolution CT compared with contrast-enhanced CT and radionuclide cisternography. AJNR Am J Neuroradiol 1999; 20 (4) 706-712
  • 20 Bell RB, Dierks EJ, Homer L, Potter BE. Management of cerebrospinal fluid leak associated with craniomaxillofacial trauma. J Oral Maxillofac Surg 2004; 62 (6) 676-684
  • 21 Mincy JE. Posttraumatic cerebrospinal fluid fistula of the frontal fossa. J Trauma 1966; 6 (5) 618-622
  • 22 Prosser JD, Vender JR, Solares CA. Traumatic cerebrospinal fluid leaks. Otolaryngol Clin North Am 2011; 44 (4) 857-873 , vii
  • 23 Eljamel MS, Foy PM. Acute traumatic CSF fistulae: the risk of intracranial infection. Br J Neurosurg 1990; 4 (5) 381-385
  • 24 Ratilal BO, Costa J, Sampaio C, Pappamikail L. Antibiotic prophylaxis for preventing meningitis in patients with basilar skull fractures. Cochrane Database Syst Rev 2011; (8) CD004884
  • 25 Kirtane MV, Gautham K, Upadhyaya SR. Endoscopic CSF rhinorrhea closure: our experience in 267 cases. Otolaryngol Head Neck Surg 2005; 132 (2) 208-212
  • 26 Rocchi G, Caroli E, Belli E, Salvati M, Cimatti M, Delfini R. Severe craniofacial fractures with frontobasal involvement and cerebrospinal fluid fistula: indications for surgical repair. Surg Neurol 2005; 63 (6) 559-563 , discussion 563–564
  • 27 Ray BS, Bergland RM. Cerebrospinal fluid fistula: clinical aspects, techniques of localization, and methods of closure. J Neurosurg 1969; 30 (4) 399-405
  • 28 McCormack B, Cooper PR, Persky M, Rothstein S. Extracranial repair of cerebrospinal fluid fistulas: technique and results in 37 patients. Neurosurgery 1990; 27 (3) 412-417
  • 29 Persky MS, Rothstein SG, Breda SD, Cohen NL, Cooper P, Ransohoff J. Extracranial repair of cerebrospinal fluid otorhinorrhea. Laryngoscope 1991; 101 (2) 134-136
  • 30 Hirsch O. Successful closure of cere brospinal fluid rhinorrhea by endonasal surgery. AMA Arch Otolaryngol 1952; 56 (1) 1-12
  • 31 Vrabec DP, Hallberg OE. Cerebrospinal Fluid Rhinorrhea. Intranasal Approach, Review of the Literature, and Report of a Case. Arch Otolaryngol 1964; 80: 218-229
  • 32 Wigand ME. Transnasal ethmoidectomy under endoscopical control. Rhinology 1981; 19 (1) 7-15
  • 33 Papay FA, Maggiano H, Dominquez S, Hassenbusch SJ, Levine HL, Lavertu P. Rigid endoscopic repair of paranasal sinus cerebrospinal fluid fistulas. Laryngoscope 1989; 99 (11) 1195-1201
  • 34 Mattox DE, Kennedy DW. Endoscopic management of cerebrospinal fluid leaks and cephaloceles. Laryngoscope 1990; 100 (8) 857-862
  • 35 McMains KC, Gross CW, Kountakis SE. Endoscopic management of cerebrospinal fluid rhinorrhea. Laryngoscope 2004; 114 (10) 1833-1837
  • 36 Locatelli D, Rampa F, Acchiardi I, Bignami M, De Bernardi F, Castelnuovo P. Endoscopic endonasal approaches for repair of cerebrospinal fluid leaks: nine-year experience. Neurosurgery 2006; 58 (4) (Suppl. 02) ONS-246-ONS-256 , ONS-256–ONS-257
  • 37 Martin TJ, Loehrl TA. Endoscopic CSF leak repair. Curr Opin Otolaryngol Head Neck Surg 2007; 15 (1) 35-39
  • 38 Messerklinger W. [Nasal endoscopy: demonstration, localization and differential diagnosis of nasal liquorrhea]. HNO 1972; 20 (9) 268-270
  • 39 Keerl R, Weber RK, Draf W, Wienke A, Schaefer SD. Use of sodium fluorescein solution for detection of cerebrospinal fluid fistulas: an analysis of 420 administrations and reported complications in Europe and the United States. Laryngoscope 2004; 114 (2) 266-272
  • 40 Hegazy HM, Carrau RL, Snyderman CH, Kassam A, Zweig J. Transnasal endoscopic repair of cerebrospinal fluid rhinorrhea: a meta-analysis. Laryngoscope 2000; 110 (7) 1166-1172
  • 41 Hadad G, Bassagasteguy L, Carrau RL , et al. A novel reconstructive technique after endoscopic expanded endonasal approaches: vascular pedicle nasoseptal flap. Laryngoscope 2006; 116 (10) 1882-1886
  • 42 Kassam AB, Thomas A, Carrau RL , et al. Endoscopic reconstruction of the cranial base using a pedicled nasoseptal flap. Neurosurgery 2008; 63 (1) (Suppl. 01) ONS44-ONS52 , discussion ONS52–ONS53
  • 43 Harvey RJ, Sheahan PO, Schlosser RJ. Inferior turbinate pedicle flap for endoscopic skull base defect repair. Am J Rhinol Allergy 2009; 23 (5) 522-526
  • 44 Prevedello DM, Barges-Coll J, Fernandez-Miranda JC , et al. Middle turbinate flap for skull base reconstruction: cadaveric feasibility study. Laryngoscope 2009; 119 (11) 2094-2098
  • 45 Fortes FS, Carrau RL, Snyderman CH , et al. Transpterygoid transposition of a temporoparietal fascia flap: a new method for skull base reconstruction after endoscopic expanded endonasal approaches. Laryngoscope 2007; 117 (6) 970-976
  • 46 Oliver CL, Hackman TG, Carrau RL , et al. Palatal flap modifications allow pedicled reconstruction of the skull base. Laryngoscope 2008; 118 (12) 2102-2106