Perioperative Considerations and Complications of Skull Base Cerebrospinal Fluid Leaks

Successful and enduring repair of cerebrospinal fluid leaks requires careful consideration of multiple factors beyond the technical execution of the surgery. This begins with thorough preoperative risk assessment and optimization of medical comorbidities, particularly elevated intracranial pressure. It continues intraoperatively with positioning and anesthetic strategies designed to maintain a stable surgical environment. Finally, diligent postoperative management, including activity restrictions, management of associated conditions such as obstructive sleep apnea and obesity, and vigilance for both early and delayed complications, is vital for protecting the repair, and appropriately managing complications. In this article, critical perioperative risk factors and clinical decisions are discussed.