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Case report: Recurrent spontaneous cerebrospinal fluid (CSF) leak

Bashayer Salem Alsaeedi1, Hussein Ali Alzamel1, Ahmad Rasheed Alrasheedi1

  • 1ENT Department, Al-Farwaniya Hospital, Al-Farwaniya, Kuwait.

International Journal of Surgery Case Reports
|November 5, 2022
PubMed

Insights

Spontaneous cerebrospinal fluid (CSF) leaks can recur on the opposite side, even after successful repair. Managing increased intracranial pressure is crucial before and after skull base surgery to prevent recurrence.

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.
Abstract

Keywords:
CSF leakCase reportIntracranial pressureSkull baseSpontaneous

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