Spinal anesthesia for a parturient with an iatrogenic skull base defect and CSF leak

A patient with an iatrogenic skull base defect and cerebrospinal fluid leak presented with rupture of amniotic membranes at 37 weeks' gestation. She had daily rhinorrhea that began in her first trimester of pregnancy and 11 months after endoscopic sinus surgery performed for chronic sinusitis. Consultation among the otolaryngologist, obstetrician, and obstetrical anesthesiologist were completed during the patient's second trimester to determine the most desirable type of delivery and anesthesia. A cesarean section was performed so as to avoid pushing in the second stage of labor that could worsen the cerebrospinal fluid leak. A spinal anesthetic was performed uneventfully. The patient had an unremarkable recovery from the operative delivery and spinal anesthesia. The pathophysiology, management, and anesthetic concerns of patients with cerebrospinal fluid leaks are reviewed.