Cerebrospinal fluid fistula surgical treatment [Neurosurgery Wiki]

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====== Cerebrospinal fluid fistula surgical treatment ======


===== General information =====

If the site of [[leakage]] is not identified prior to attempted surgical treatment, 30% develop a recurrent leak post-op, with 5–15% of these developing meningitis before the leak is stopped
((Naidich TP, Moran CJ. Precise Anatomic Localization of Atraumatic Sphenoethmoidal CSF Rhinorrhea by Metrizamide CT Cisternography. J Neurosurg. 1980; 53:222–228)).

There is currently no most ideal [[technique]] among the available options. The choice of which technique to be applied in each case is dependent on each surgeon's cumulative experience as well as a clear understanding of the contributory underlying factors in each patient, the nature and site of the leak, the available facilities and equipment
((Menon SK, Onyia CU. A short review on a complication of lumbar spine surgery: 
Cerebrospinal fluid fistula. Clin Neurol Neurosurg. 2015 Oct 23;139:248-251. doi:
10.1016/j.clineuro.2015.10.013. [Epub ahead of print] Review. PubMed PMID:
26523872.
)).

===== Indications for surgical intervention =====

1. [[Traumatic Cerebrospinal fluid fistula]] that persists > 2 weeks in spite of non-surgical measures

2. [[Nontraumatic cerebrospinal fluid fistula]] and those of delayed onset following trauma or surgery: usually require surgery because of a high incidence of recurrence

3. leaks complicated by recurrent meningitis


Primary and meticulous [[dural closure]] is sine qua non in preventing postoperative [[cerebrospinal fluid fistula]].

Several techniques for [[duraplasty]] and different materials for [[Water-tight dural closure]] have been described.

A plastic dummy with a balloon was developed to test the efficacy of the Water-tight closure of the dura. The technical notes to reproduce the method have been described.

The described model represents a new, simple, effective and affordable device to be used for [[neurosurgical training]] in the procedures of duraplasty and to test the efficacy of Water-tight closures
((Matula C, Kjærsgaard L, Di Ieva A. Water-tight dural closure in brain surgery: 
a simple model for training. J Neurol Surg A Cent Eur Neurosurg. 2014
May;75(3):241-5. doi: 10.1055/s-0033-1342928. PubMed PMID: 23681920.)).

===== Duraplasty =====

[[Duraplasty]]

===== Dural substitute =====

see [[Dural substitute]].

===== Dural sealant =====

[[Dural sealant]]

===== Endoscopic endonasal approach for cerebrospinal fluid fistula =====

[[Endoscopic endonasal approach for cerebrospinal fluid fistula]].

===== Spinal Dura Repair =====

[[Spinal Dura Repair]].

===== Ventriculoperitoneal shunt for cerebrospinal fluid fistula treatment =====
[[Ventriculoperitoneal shunt for cerebrospinal fluid fistula treatment]].