CSF leak, cerebrospinal fluid leak, spinal CSF leak, cranial CSF leak, CSF rhinorrhea, CSF otorrhea, dural tear, intracranial hypotension, headache CSF leak, neurosurgery CSF repair, skull base CSF leak, postoperative CSF leak, traumatic CSF leak, meningitis risk CSF leak, beta-2 transferrin test, CSF fistula, surgical CSF leak closure, endoscopic CSF repair, neurological infection prevention, long term CSF leak management

Content:
Cerebrospinal fluid leak occurs when there is a breach in the dura mater, allowing CSF to escape from the subarachnoid space. CSF leaks may be cranial or spinal and can arise from trauma, surgery, spontaneous dural defects, or skull base pathology. Persistent CSF leakage poses a significant risk of meningitis and intracranial hypotension.

Patients may present with clear fluid drainage from the nose or ear, positional headache, neck stiffness, nausea, or visual disturbances. Spinal CSF leaks often cause orthostatic headaches that worsen on standing and improve when supine. Accurate diagnosis is essential to prevent complications and guide definitive treatment.

Neurosurgical evaluation includes clinical assessment and targeted imaging. MRI and CT cisternography help localize the leak site, while biochemical analysis confirms CSF origin. Identification of leak location is critical for surgical planning.

Management depends on leak etiology and severity. Conservative measures may be attempted in selected cases, but persistent or high-risk leaks require surgical repair. Surgical objectives include dural closure and restoration of CSF integrity using direct repair or grafting techniques. Endoscopic approaches are increasingly utilized for cranial leaks.

Postoperative care focuses on monitoring for recurrence, infection, and symptom resolution. Long-term outcomes are favorable when leak closure is achieved.

CSF leaks require meticulous neurosurgical evaluation and definitive repair to prevent infection and long-term neurological complications.