Post-traumatic CSF fistulae, the case for surgical repair

The management of acute post-traumatic CSF fistulae is still a matter of controversy. A long-term analysis of 160 patients with acute post-traumatic non-iatrogenic dural fistulae was undertaken to establish the value of surgical dural repair. One hundred and forty-nine patients underwent dural repairs following traumatic CSF rhinorrhoea. The risk of meningitis following surgical dural repair was 4%. The operative mortality was 1.3% (2/151), as was the negative exploration rate. The first dural repair was successful in 90% and a second dural repair was required in 10%. These results are in favour of surgical dural repair which can be undertaken with a low morbidity and mortality and is highly successful in preventing meningitis following traumatic CSF rhinorrhoea.