title: Management of Cerebrospinal Fluid Leak following Posterior Cranial Fossa Surgery.
abstract: OBJECTIVE
  Cerebrospinal fluid leakage remains a significant cause of morbidity following posterior fossa surgery, and its treatment remains a difficult problem. The aim of the study was to propose a treatment algorithm for its management.
  
  
  METHODS
  A retrospective, single-center study was conducted on 147 patients who underwent elective posterior fossa surgeryfor a variety of diseases. Patients with post operative CSF leakage had either been treated initially with conservative measures including re-suturing of the wound, with CSF lumbar drainage to be employed in case the CSF leakage didn't stop, or the initial intervention was the institution of CSF lumbar drainage simultaneously with conservative measures. VP (ventriculo-peritoneal) shunt was done in patients with gross hydrocephalus on postoperative CT brain.
  
  
  RESULTS
  There were 25 (17%) cases of CSF leakage, including 24 incisional CSF leaks and one case of CSF otorrhea. In eight patients with incisional CSF leakage treated initially with conservative measures including re-suturing of the wound, CSF leakage stopped in only two cases. CSF lumbar drainage instituted later on in six cases with persistent leakage stopped the CSF leakage. In fourteen patients managed initially with re-suturing of the wound and concomitant CSF lumbar drainage, CSF leakage settled in all the cases. Two patients with gross hydrocephalus on post operative CT were managed successfully with VP shunt. Re-suturing of the wound with concomitant CSF lumbar drainage was found to be significantly associated (p=0.003) with the stoppage of CSF leakage, and the settlement of meningitis (p= 0.014).
  
  
  CONCLUSIONS
  IncisionalCSFleaks after posterior fossa surgery should be managed with re-suturing of the wound and concomitantCSFlumbar drainage, instead of an initial trial of conservative therapy alone.
authors.affiliation: Dr. Imran Altaf, MS. Department of Neurosurgery, Khawja Muhammad Safdar Medical College, Sialkot, Pakistan.
authors.forename: Imran
authors.initials: I
authors.lastname: Altaf
authors.affiliation: Dr. Anjum Habib Vohra, FRCS, Department of Neurosurgery, Post Graduate Medical Institute, Lahore General Hospital, Lahore, Pakistan.
authors.forename: Anjum Habib
authors.initials: AH
authors.lastname: Vohra
authors.affiliation: Dr. Shahzad Shams, FRCS, FCPS, Department of Neurosurgery, Post Graduate Medical Institute, Lahore General Hospital, Lahore, Pakistan.
authors.forename: Shahzad
authors.initials: S
authors.lastname: Shams
keywords: Cerebrospinal fluid leak; Cerebrospinal fluid lumbar drainage; Posterior cranial fossa surgery