gms | German Medical Science

Objective: A possible, rather rare complication after intracranial surgery is known as cerebrospinal fluid fistula. It occurs when the dura, despite best efforts cannot be sutured entirely or when there is a partial leak of cerebrospinal fluid after the closure during the surgery. Another rare consequence of the CSF fistula occurs when the CSF collects in a pool under the skin suture, and this is known as a pseudomeningocele. Both possibilities can lead to persistent headache and infection. Considering there are several opinions in literature regarding the methods used to treat cerebrospinal fluid fistula, this study will focus on determining the best method of treating the CSF fistula after cranial surgery at our institution.

Method: Between 2005 and 2013, thirty-one patients developed a CSF fistula after undergoing intracranial surgery at our institution. A database was used to retrospectively analyze the cases when the CSF fistula occurred, the causes of the CSF fistula, the treatment methods used and the final outcome of the treatment.

Results: 4 of 31 patients did not need any treatment. Of the 31 patients, 22 patients were initially treated by lumbar drainage, tapping and pressure dressings but only 10 cases were deemed to be successful. 17 of the 31 patients, including those that were not successfully treated with an initial lumbar drain needed surgery. Depending on the size of the leaks, we used direct sutures with or without a dura patch or fibrin sealants and tissue adhesives to glue the dural surface, sometimes combined with simultaneous lumbar drain during the operation.

Conclusions: In view of the fact that almost 50% of patients needed to undergo surgery after initial lumbar drain treatment and in order to avoid a prolonged length of stay and costs to the system, it is suggested that patients should be primarily treated by surgery when diagnosed with cerebrospinal fistula following intracranial surgery. Due to the heterogeneity of the pathology, tissue characteristics of the dura, different approaches and surgical techniques, the best surgical way of achieving not only a water-tight but also an air-tight dural repair remains an individual decision.