title: Management of cerebrospinal fluid leaks after vestibular schwannoma surgery.
abstract: OBJECTIVE
  To evaluate the incidence and treatment of cerebrospinal fluid (CSF) leaks after resection of vestibular schwannomas and to propose a treatment algorithm for their management.
  
  
  METHODS
  Retrospective chart review.
  
  
  METHODS
  Tertiary referral center.
  
  
  METHODS
  Review of 1,922 subjects who underwent resection of vestibular schwannomas from 1970 to 2010.
  
  
  METHODS
  Surgical resection of vestibular schwannoma.
  
  
  METHODS
  Patient demographics, surgical approach used, CSF leak incidence, meningitis, treatment, and success in the management of CSF leaks.
  
  
  RESULTS
  Postoperative CSF leaks were observed in 12.9% of our patients. There was no significant difference between the type of approach and the presence of CSF leak with translabyrinthine, suboccipital and middle fossa CSF leak rates of 12%, 12%, and 13%, respectively (p = 0.07). Patients presented with a wound leak or rhinorrhea almost equally. Ultimately, 92% of patients with rhinorrhea underwent surgical intervention. The probability of a patient with rhinorrhea requiring a second intervention was higher when the initial intervention was conservative rather than surgical. However, the probability of a patient with a wound leak requiring a second intervention was essentially the same when initially treated conservatively or surgically.
  
  
  CONCLUSIONS
  Our data suggests that there is no difference in CSF leak rates between the different surgical approaches. The appropriate treatment strategy is dependent on the presentation of the CSF. Although conservative treatment is effective for managing wound leaks, it is less effective in managing patients with rhinorrhea. Therefore, surgical treatments should play an early role in the treatment algorithm of patients with CSF rhinorrhea.
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, Vanderbilt Bill Wilkerson Center, Vanderbilt University, Nashville, Tennessee 37232, USA. brannon.mangus@vanderbilt.edu
authors.forename: Brannon D
authors.initials: BD
authors.lastname: Mangus
authors.forename: Alejandro
authors.initials: A
authors.lastname: Rivas
authors.forename: Mi Jin
authors.initials: MJ
authors.lastname: Yoo
authors.forename: JoAnn
authors.initials: J
authors.lastname: Alvarez
authors.forename: George B
authors.initials: GB
authors.lastname: Wanna
authors.forename: David S
authors.initials: DS
authors.lastname: Haynes
authors.forename: Marc L
authors.initials: ML
authors.lastname: Bennett
mesh_terms: D000328:Adult; D002559:Cerebrospinal Fluid Rhinorrhea / Q000453:epidemiology / Q000209:etiology / Q000601:surgery*; D004322:Drainage; D006801:Humans; D015994:Incidence; D009464:Neuroma, Acoustic / Q000601:surgery*; D013506:Otologic Surgical Procedures / Q000009:adverse effects*; D012189:Retrospective Studies