Management of CSF leak in base of skull fractures in adults.
OBJECTIVE
CSF leaks are not uncommon after a base of skull fracture. Currently there is no standardised algorithm for the investigation and management of post-traumatic CSF leaks. In this paper we aim to provide an evidence-based framework for managing post-traumatic CSF leaks.


METHODS
We searched the English literature over the past 45 years using CINAHL, EMBASE and MEDLINE for the terms (1) post-traumatic CSF leaks or fistulas, and (2) basilar or base of skull fractures, but excluded papers on post-operative and non-traumatic CSF leaks, and papers on paediatric post- traumatic CSF leaks.


RESULTS
The diagnosis of a base of skull fracture and any resultant CSF leak can be challenging. Therefore a combination of biochemical and radiological studies are needed to optimise the diagnosis of this condition. Post-traumatic CSF leaks are generally treated conservatively, and a majority of them resolve without further surgical management. However for patients who are refractory to such treatments, surgical closure of the CSF fistula is necessary. Surgical obliteration of CSF leaks can be challenging and requires the involvement of multiple surgical specialties such as neurosurgery, otolaryngology, and maxillofacial surgery.


CONCLUSIONS
Although we have formulated a simple algorithm to aid the investigation and management of post-traumatic CSF leaks, there are still many important unresolved questions requiring further well powered studies to answer.
a South West Neurosurgery Centre , Plymouth Hospitals NHS Trust , Plymouth , UK.
See Yung
SY
Phang
a South West Neurosurgery Centre , Plymouth Hospitals NHS Trust , Plymouth , UK.
Kathrin
K
Whitehouse
b Department of Neuroradiology , Plymouth Hospitals NHS Trust , Plymouth , UK.
Lucy
L
Lee
c Department of Maxillofacial Surgery , Plymouth Hospitals NHS Trust , Plymouth , UK.
Hisham
H
Khalil
d Department of ENT , Plymouth Hospitals NHS Trust , Plymouth , UK.
Paul
P
McArdle
a South West Neurosurgery Centre , Plymouth Hospitals NHS Trust , Plymouth , UK.
Peter C
PC
Whitfield
D065634:Cerebrospinal Fluid Leak / Q000209:etiology* / Q000628:therapy*; D019317:Evidence-Based Medicine; D006801:Humans; D019291:Skull Base / Q000293:injuries*; D012887:Skull Fractures / Q000134:cerebrospinal fluid* / Q000150:complications*
Cerebrospinal fluid; skull fracture; surgical management; treatment