Spontaneous cerebrospinal fluid leaks.
OBJECTIVE
Cerebrospinal fluid leaks that occur spontaneously are challenging to manage clinically owing to frequent recurrences following attempted surgical closure. Understanding of the underlying pathophysiology has increased in recent years as we now recognize that the vast majority of these patients demonstrate clinical symptoms and radiographic signs of elevated intracranial pressure. Individuals with this disorder also arise from a distinct demographic group. Increased knowledge of the characteristics of this patient population along with updated medical and surgical management will provide increased success rates in the management of this clinical entity.


RESULTS
Current literature indicates that control of intracranial hyptertension, coupled with endoscopic repair, will improve success rates comparable with other etiologies. Recent information on the underlying pathophysiology of spontaneous cerebrospinal fluid leaks is discussed. Improvement in preoperative identification of radiographic signs of intracranial hypertension (i.e. empty sella), operative technique, and postoperative management of elevated intracranial pressure are also reviewed.


CONCLUSIONS
We highlight the demographic characteristics, clinical presentation, radiologic findings, and clinical management of patients with this disorder.
Woodworth
Bradford A
BA
Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, University of Alabama at Birmingham, Birmingham, Alabama, USA.
Palmer
James N
JN
D000208:Acute Disease; D002559:Cerebrospinal Fluid Rhinorrhea / Q000175:diagnosis / Q000209:etiology* / Q000601:surgery*; D004652:Empty Sella Syndrome / Q000150:complications / Q000175:diagnosis; D004724:Endoscopy / Q000379:methods*; D005260:Female; D006801:Humans; D019586:Intracranial Hypertension / Q000150:complications / Q000175:diagnosis; D008279:Magnetic Resonance Imaging; D008297:Male; D011300:Preoperative Care / Q000379:methods; D011379:Prognosis; D018570:Risk Assessment; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome