Case report: Recurrent spontaneous cerebrospinal fluid (CSF) leak

Area of Science:

• Neurosurgery
• Cerebrospinal Fluid Dynamics
• Skull Base Surgery

Background:

• Spontaneous cerebrospinal fluid (CSF) leaks are often associated with factors like obesity, middle age, female sex, and elevated intracranial pressure.
• Recurrence of CSF leaks, particularly on the contralateral side, poses a significant clinical challenge.

Observation:

• A middle-aged female with a history of right-sided CSF leak, confirmed by Beta-2 Transferrin and CT scan, underwent surgical repair.
• One year later, the patient presented with symptoms indicative of a CSF leak on the left side, the opposite of the initial presentation.

Findings:

• This case highlights the potential for spontaneous CSF leaks to occur or recur on the contralateral side following initial surgical intervention.
• The recurrence suggests that underlying predisposing factors, such as elevated intracranial pressure, may persist or contribute to new leak formation.

Implications:

• Effective management of increased intracranial pressure is paramount both pre- and post-operatively for skull base repairs.
• Addressing elevated intracranial pressure may be key to preventing both ipsilateral and contralateral recurrence of spontaneous CSF leaks.