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Related Concept Videos

Cerebral Edema ll: Pathophysiology01:22

Cerebral Edema ll: Pathophysiology

Vasogenic edema is a major form of cerebral edema characterized by abnormal accumulation of fluid in the brain’s extracellular space due to disruption of the blood–brain barrier (BBB). The BBB is a specialized structure composed of endothelial cells connected by tight junctions, supported by astrocytic endfeet and a basement membrane. Under normal conditions, it tightly regulates the movement of ions, proteins, and solutes between the bloodstream and brain parenchyma. When this barrier loses...
Increased Intracranial Pressure ll: Pathophysiology01:29

Increased Intracranial Pressure ll: Pathophysiology

Increased intracranial pressure (ICP) refers to a potentially life-threatening rise in pressure inside the skull. This usually happens when there is a major change in the volume of brain tissue, blood, or cerebrospinal fluid (CSF) — the three components inside the skull. According to the Monro-Kellie doctrine, if the volume of one component increases, the volumes of the other components must decrease to maintain normal pressure. If this does not happen, ICP rises.The process often begins with...
Brain Abscess l: Introduction01:26

Brain Abscess l: Introduction

A brain abscess is a focal, intracerebral infection characterized by a localized collection of pus within the brain parenchyma, resulting from microbial invasion and the body’s inflammatory response. It progresses through stages: early and late cerebritis, followed by early and late capsule formation, reflecting tissue destruction, immune response, and eventual encapsulation.Etiology and PathogenesisCausative organisms vary with source and host factors, often involving polymicrobial infections,...
Cerebral Edema l: Introduction01:19

Cerebral Edema l: Introduction

Cerebral edema is a pathological increase in brain water content that disrupts intracranial pressure regulation and impairs neurological function. Because the cranial vault is rigid, even modest increases in tissue volume can compromise cerebral perfusion, distort neural structures, and initiate secondary injury. Cerebral edema develops through four principal mechanisms: vasogenic, cytotoxic, interstitial, and ionic.Vasogenic EdemaVasogenic edema arises from disruption of the blood–brain...
Cerebrospinal Fluid01:21

Cerebrospinal Fluid

Cerebrospinal fluid (CSF) is a colorless liquid that flows around the brain and the spinal cord, playing a vital role in the protection, support, and overall function of the central nervous system (CNS). CSF production, circulation, and absorption are tightly regulated processes essential for the brain and spinal cord to function properly.
CSF Production
CSF is produced mainly in the choroid plexus, a network of capillaries and ependymal cells located within the ventricular system of the brain.
Increased Intracranial Pressure l: Introduction01:14

Increased Intracranial Pressure l: Introduction

Intracranial hypertension is a sustained elevation of intracranial pressure (ICP) above 22 mm Hg. In supine adults, normal ICP is ~7–15 mm Hg.The rigid, nonexpandable cranium contains three components—brain tissue, blood, and cerebrospinal fluid (CSF)—that total ~1,700 mL in a typical adult: 1,400 mL brain (~80%), 150 mL blood (~10%), and 150 mL CSF (~10%). According to the Monro–Kellie doctrine, total intracranial volume is effectively fixed. When one component expands, CSF and venous blood...

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Intrathecal Application of a Fluorescent Dye for the Identification of Cerebrospinal Fluid Leaks in Cochlear Malformation
06:59

Intrathecal Application of a Fluorescent Dye for the Identification of Cerebrospinal Fluid Leaks in Cochlear Malformation

Published on: February 29, 2020

An Updated Comprehensive Management Algorithm for Anterior and Lateral Spontaneous Cerebrospinal Fluid Leaks.

Emma J Anisman1, Shreya Mandloi1, Abdulghafoor Alani1

  • 1Department of Otolaryngology - Head and Neck Surgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA.

Neurosurgery
|June 4, 2026
PubMed
Summary
This summary is machine-generated.

Surgical repair of spontaneous cerebrospinal fluid (CSF) leaks is effective when combined with management of elevated intracranial pressure (ICP). This approach, including shunting or stenting, reduces recurrence and improves outcomes for CSF leak patients.

Keywords:
Cerebrospinal fluid leakIdiopathic intracranial hypertensionIntracranial pressure

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Area of Science:

  • Neurosurgery
  • Neurology
  • Otolaryngology

Background:

  • Spontaneous cerebrospinal fluid (CSF) leaks often stem from elevated intracranial pressure (ICP).
  • Inadequate ICP management post-surgery can lead to persistent symptoms and recurrent CSF leaks.
  • Treatment options for elevated ICP include diuretics, weight loss, ventriculoperitoneal shunting (VPS), and venous sinus stenting (VSS).

Purpose of the Study:

  • To present a large series on managing spontaneous CSF leaks using surgery, VPS, and VSS.
  • To develop a treatment algorithm for spontaneous CSF leaks secondary to elevated ICP.
  • To evaluate the efficacy and safety of surgical repair and ICP management strategies.

Main Methods:

  • Retrospective review of 190 patients with spontaneous anterior or lateral skull base CSF leaks treated surgically (2005-2025).
  • Analysis of radiographic imaging, lumbar puncture opening pressures, and patient outcomes.
  • Development of a treatment algorithm based on collected data.

Main Results:

  • Elevated ICP was managed with VPS in 34.2%, VSS in 5.8%, and combined VPS/VSS in 2.1% of patients.
  • Postoperative CSF leak recurrence occurred in 4.2% of patients without VPS/VSS, and only one recurrence was noted after VPS and/or VSS placement.
  • Complications occurred in 26% of patients after VPS, with no complications reported after VSS.

Conclusions:

  • Surgical closure of skull base defects combined with ICP management is a successful strategy for spontaneous CSF leaks.
  • A proposed algorithm guides ICP management using lumbar puncture opening pressures and trans-stenotic pressure gradients.
  • This approach aims to optimize medical and surgical recommendations for elevated ICP in CSF leak patients.