[Cerebrospinal fluid leak after cranial base surgery]

We investigated the incidence, prevention and management of postoperative cerebrospinal fluid (CSF) leaks in 64 cranial base surgeries (18 transzygomatic subtemporal approaches, 14 transpetrous approaches, 21 suboccipital approaches and 11 lateral approaches). The incidence was 13% (8/64); the lateral approach had the highest incidence (25%) among the four surgical approaches. The CSF leakage usually occurred as rhinorrhea, but the lateral approach resulted in the subcutaneous CSF retention and CSF leakage from the surgical wound. Six CSF leaks developed within 10 days after surgery ("early onset") and two developed 21 and 23 days after surgery ("late onset"). Preventive lumbar CSF drainage was significantly effective. Post-operative CSF leak occurred in none of 8 cases using preventive lumbar CSF drainage and in 8 out of 56 cases without it (P < 0.01). Lumbar CSF drainage was also effective in the treatment of the postoperative CSF leaks; it cured 5 out of 8 CSF leaks. All of the five CSF leaks which were cured by lumbar drainage were of the "early onset" type. Both of the two "late onset" CSF leaks needed surgical treatment.