Unfortunately, the rate of recurrence after surgical repair in cases of spontaneous CSF leaks (25–87%) is much higher than the rates (<10%) reported after repair of CSF leaks with other etiologies. Repair of anterior cranial base CSF leaks is now mostly done endoscopically through the nose to decrease the morbidity associated with open approaches. Life-threatening sequelae have been associated with CSF leaks, such as ascending meningitis or brain abscess. The etiology of spontaneous CSF leaks has not yet been elucidated however, it is associated with increased intracranial pressure (ICP) than the tensile strength of the disrupted tissues thus, it is considered as a variant of idiopathic intracranial hypertension (IIH). Defects in the skull base may occur congenitally, due to trauma, neoplasm, or spontaneously. The leakage of cerebrospinal fluid (CSF) may occur due to the development of defect(s) in the mucosa, skull bone, and meningeal membranes. Future prospective studies with larger sample sizes should confirm the efficacy and safety of this management plan. Success rate is higher in patients with spontaneous CSF leaks and CSF hypertension treated by lumbo-peritoneal shunt. Lumbo-peritoneal shunt was inserted for all our patients. The mean preoperative CSF pressure was 36.5 ± 1.7 mm H 2O. Encephalocele and meningocele were encountered in 61.1% and 66.7% of cases, respectively. About one third of cases had multiple defects. The most common sites of leakage were the cribriform (66.7%), followed by both cribriform and ethmoidal (16.7%), sphenoid (11.1%), and ethmoidal (5.6%) bones. Meningitis was recorded in two patients (11.1%). All patients presented with headache and visual complaints. Most patients were obese (BMI = 33.6 ± 1.8 kg/m 2) women (88.9%), with sleep apnea syndrome (77.8%). ResultsĮighteen patients were included in this study. All patients had increased ICP and were subjected to endoscopic repair and lumbo-peritoneal shunt procedure. MethodsĪ retrospective cohort study reviewed patients with recurrent spontaneous CSF leaks over a 4-year period. This study was conducted to evaluate the impact of lumbo-peritoneal CSF shunt following the initial as well as recurrent repair of spontaneous CSF leaks to avoid recurrence. There is still controversy regarding the use of lumbo-peritoneal shunt to prevent its recurrence. Most cases had increased intracranial pressure (ICP) on presentation. Spontaneous cerebrospinal fluid (CSF) leaks are associated with high morbidity and recurrence rates.

Spontaneous cerebrospinal fluid leak