Cranial CSF fistula [Neurosurgery Wiki]

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====== Cranial CSF fistula ======

===== Key concepts =====

● suspect in posttraumatic [[otorrhea]]/[[rhinorrhea]] or [[recurrent]] [[meningitis]]

● management strategy: 

1) confirm the [[fluid]] is [[CSF]] 

2) identify the site of origin of the [[leak]]

3) determine the [[etiology]]/mechanism

● most bedside tests are unreliable and include: “reservoir sign,” target/halo sign, qualitative [[glucose]]

● the most accurate confirmatory test is β2-[[transferrin]]

● CT [[cisternography]] is the test of choice for localizing site of the fistula
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Non-traumatic CSF leak may be spontaneous in the absence of obvious cause, such as skull base abnormalities or bone erosion related to tumors or hydrocephalus
((Ommaya AK. Cerebrospinal Fluid Rhinorrhea. Neurology. 1964;14:106–113.))
((Clark D, Bullock P, Hui T, et al. Benign intracranial hypertension: a cause of CSF rhinorrhoea. J Neurol Neurosurg Psych. 1994;57:847–849.))
((Yang Z, Wang B, Wang C, et al. Primary spontaneous cerebrospinal fluid rhinorrhea: a symptom of idiopathic intracranial hypertension? J Neurosurg. 2011;115:165–170.)).