General
- Early extended approaches series 15-30% leak rates
- When to repair
- How to repair
- Get out jail repairs
Risk factor for CSF leak
- Pre-op risk factors
- Craniopharyngioma / Meningioma
- Hydrocephalus
- High BMI
- OSA?
- Revision Surgery
- Size of tumour
- Suprasellar extension / lobulated tumour
- Postop risk factors
- High BMI
- Age
- Tumour Size
- Craniopharyngioma / Meningioma
Identify
- Higher volume leak easier to identify
- Low volume leaks can be difficult
- Lumbar drain may make identification more difficult (leave clamped)
- High volume CSF loss during surgery may make identification difficult after closure (pneumocephalus)
Cerebrospinal fluid leak grading system
Grade of leak | Description of leak |
Absence of cerebrospinal fluid leak, confirmed by Valsalva maneuver | |
Small "weeping" leak, confirmed by Valsalva maneuver, without obvious or with only small diaphragmatic defect | |
Moderate cerebrospinal fluid leak, with obvious diaphragmatic defect | |
Large cerebrospinal fluid leak, typically created as part of extended transsphenoidal approach through the supradiaphragmatic or clival dura for tumor access |
- Reference: Esposito 2007
- Grade 0
- Grade 1
- Grade 2
- Grade 3
Types of repair
- None (inadvisable?)
- Absorbable allograft
- Non absorbable allograft
- Sealant glue/spray
- Non-vascularised autograft (fat/muscle/fascia)
- Vascularised autograft (flaps)
- Graft buttress (balloons/bone/synthetics)
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