Cerebrospinal fluid dynamics in skull base surgery.
OBJECTIVE
This review examines disturbances of cerebrospinal fluid (CSF) dynamics after skull base surgical and endoscopic approaches. Despite the continuing advancements and the effectiveness of skull base surgery, the incidence of postoperative rhinorrhea remains problematic. This adverse event carries a significant potential for major neurologic insult related to infection of the central nervous system.


RESULTS
The contemporary literature provides excellent reports that summarize the management of this important clinical entity focusing on particular aspects of its diagnosis and treatment. Advances in various imaging technologies have enabled the accurate localization of CSF fistulas. However, their complexity requires physicians to have significant knowledge about the advantages and limitations of each test.


CONCLUSIONS
Patients with CSF leaks are often referred to otolaryngologists to undergo transnasal endoscopic treatment. When CSF leaks are severe, recurrent, or not amenable to endoscopic treatment (previous posterior fossa or transpetrosal approach), the treatment choice is open repair through craniotomy.
Darakchiev
Borimir J
BJ
The Neuroscience Institute, University of Cincinnati, Cincinnati, OH 45267-0528, USA.
Pensak
Myles L
ML
D001927:Brain Diseases / Q000134:cerebrospinal fluid / Q000175:diagnosis / Q000601:surgery*; D002559:Cerebrospinal Fluid Rhinorrhea / Q000209:etiology / Q000503:physiopathology / Q000601:surgery*; D004724:Endoscopy / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D019635:Neurosurgical Procedures / Q000009:adverse effects* / Q000379:methods; D013517:Otorhinolaryngologic Surgical Procedures / Q000379:methods; D018570:Risk Assessment; D012720:Severity of Illness Index; D019291:Skull Base / Q000601:surgery*; D016896:Treatment Outcome