Cerebrospinal Fluid Leaks From the Lateral Ventricle: A Case Series

Area of Science:

• Neurosurgery
• Skull Base Surgery
• Cerebrospinal Fluid Dynamics

Background:

• Lateral skull base (LSB) cerebrospinal fluid (CSF) leaks are complex neurosurgical conditions.
• Leaks originating from the lateral ventricle represent a rare and challenging subset.
• Understanding their etiology and effective management is crucial for patient outcomes.

Observation:

• This retrospective case review analyzed three patients with LSB CSF leaks originating from the lateral ventricle.
• All patients presented with temporal lobe encephalomalacia, attributed to trauma in one and neurodegeneration in two.
• Two patients experienced preoperative meningitis, highlighting the potential for serious complications.

Findings:

• The middle cranial fossa (MCF) surgical approach was employed for all patients, achieving complete resolution of CSF leaks.
• Despite the presence of encephalomalacia and high-flow CSF leaks, no major postoperative complications occurred.
• Patient characteristics, including body mass index (BMI), did not significantly differ from those with spontaneous CSF leaks through middle fossa defects, except for a higher incidence of meningitis.

Implications:

• The middle cranial fossa approach is effective for repairing LSB CSF leaks from the lateral ventricle, even in cases with brain parenchyma loss.
• These rare leaks can occur in non-obese individuals and are associated with temporal lobe encephalomalacia.
• Early diagnosis and surgical intervention via MCF are crucial for successful management and prevention of complications like meningitis.