A Clinical Fallacy: Myth of Meningitis-Driven Dural Healing in Post-traumatic Cerebrospinal Fluid Leaks

This systematic review evaluates the management of cerebrospinal fluid (CSF) leaks following traumatic skull base fractures and examines the associated risk of post-traumatic meningitis (PTM). It also critically investigates the debated hypothesis that meningitis may promote spontaneous closure of defects in the dura mater through inflammation-induced healing. A comprehensive literature search was performed using PubMed, Scopus, and the Cochrane Library according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Out of 8,441 records initially screened, 57 full-text articles were reviewed, and 11 studies were included in the final qualitative synthesis. Extracted data included patient demographics, characteristics of CSF leakage, treatment strategies, incidence of meningitis, and clinical outcomes. A total of 216 patients were analyzed, most of whom were young adult males with skull base fractures involving the frontal sinus, ethmoid roof, or cribriform plate. Conservative treatment methods, such as bed rest, head elevation, and blood pressure control, showed success rates ranging from 39.5% to 85%, particularly in middle cranial fossa (MCF) injuries. Surgical repair was ultimately required in 46% of cases, with success rates ranging from 59.3% to 77%. Meningitis developed in 27% of patients, with the highest risk observed in those with delayed or recurrent CSF leakage. The use of prophylactic antibiotics produced inconsistent outcomes, and the recurrence rate was notably higher among those treated conservatively. Traumatic CSF leaks carry a significant risk of infection, especially when diagnosis or treatment is delayed. While isolated reports have suggested that meningitis-induced inflammation might aid in healing, the evidence from this review does not support that claim. Instead, meningitis more frequently impairs healing and increases the likelihood of complications. Prompt identification, individualized treatment planning, and infection prevention are essential to optimize outcomes.