Cerebrospinal fluid fistula treatment

Acutely after trauma, observation is justified as most cases cease spontaneously.

Prophylactic antibiotics for cerebrospinal fluid fistula

Pneumococcal vaccine: recommended for adults age 2–65 years ¹⁾.

1. measures to lower ICP:

a) bed rest: although recumbency may ameliorate symptoms, there is no other benefit from bed rest ²⁾

b) avoid straining (stool softeners) and avoid blowing nose

c) acetazolamide (250 mg PO QID) to reduce CSF production

d) modest fluid restriction;caution post-transsphenoidal because of possible DI: 1500 ml/day in adults, 75% of maintenance/day in peds

2. if the leak persists (caution: first R/O obstructive hydrocephalus with CT or MRI)

a) LP: QD to BID (lower pressure to near atmospheric or until H/A) OR

b) continuous external lumbar cerebrospinal fluid drainage:

see External lumbar cerebrospinal fluid drainage for cerebrospinal fluid fistula.

3. surgical treatment in persistent cases

see External lumbar cerebrospinal fluid drainage for cerebrospinal fluid fistula.

Cerebrospinal fluid fistula surgical treatment.