Abstract
Program Description: Spontaneous cerebrospinal fluid (CSF) fistula is an important emerging clinical entity that may be related to excess production or inadequate resorption of CSF. The recurrence rates for spontaneous leaks are higher than other etiologies and may be related to underlying elevated intracranial pressure. Spontaneous CSF leaks generally present with otorrhea or rhinorrhea depending on the site of leakage in the anterior, middle, or posterior cranial fossa. Successful management requires accurate diagnosis and timely surgical repair to minimize the risk of associated infectious intracranial complications. This miniseminar will comprehensively review the diagnostic and treatment algorithm for management of spontaneous CSF rhinorrhea and otorrhea. Salient pathophysiologic mechanisms will be discussed. The role of imaging studies, including computed tomography, magnetic resonance imaging, and radionuclide studies, will be outlined. Open and endoscopic techniques for repair of rhinologic and otologic leaks will be reviewed. The utility of various graft materials and role of lumbar drainage will be explored. Long-term management strategies for increased intracranial pressure, including use of diuretics and shunting, will be discussed. Multidisciplinary approach with close collaboration with neurosurgery, neurology, and neuro-ophthalmology will be stressed. A case-based format will be used to illustrate key clinical points.
Educational Objectives: 1) Be able to use the diagnostic modalities available to diagnose and localize spontaneous cerebrospinal fluid fistulas. 2) Understand the various lateral and anterior skull base approaches used for repair of cerebrospinal fluid leaks. 3) Appreciate the importance of the multidisciplinary approach and treatment of underlying concurrent conditions, such as benign intracranial hypertension.