Management of Intracranial Hypotension and Cerebrospinal Fluid Leaks

  • David L. DornbosIII
  • Nathaniel Toop
  • Ammar Shaikhouni
  • H. Wayne Slone
  • John M. McGregorEmail author


Intracranial hypotension and cerebrospinal fluid (CSF) leaks may occur secondary to numerous pathologies, including trauma, iatrogenic injury, or even in a spontaneous manner. A diagnostic hallmark of intracranial hypotension is the presence of low CSF volume rather than low CSF pressure. As such, intracranial hypotension may occur in the setting of low, normal, or elevated intracranial pressure. The diagnostic evaluation of this pathology, in addition to localization of a potential leak, can be challenging, requiring numerous noninvasive and invasive imaging modalities, including computed tomography (CT), magnetic resonance imaging (MRI), lumbar puncture, myelography, or cisternography. While medical management can provide symptomatic relief, definitive treatment of the source of the pathology depends on the etiology of the CSF leak. Depending on the source and localization of the CSF leak, less invasive means of CSF diversion may be sufficient, or patients may require definitive repair of the CSF fistula. Ultimately, proper evaluation and correct diagnosis of the pathology driving the CSF leak frame the paradigm for treatment of intracranial hypotension.


Idiopathic intracranial hypertension Cerebrospinal fluid (CSF) leak Idiopathic intracranial hypotension Blood patch Pseudotumor cerebri Acquired Chiari type I malformation CSF hypotension 


  1. 1.
    Loew F, Pertuiset B, Chaumier EE, Jaksche H. Traumatic, spontaneous and postoperative CSF rhinorrhea. Adv Tech Stand Neurosurg. 1984;11:169–207.PubMedCrossRefGoogle Scholar
  2. 2.
    Carrau RL, Snyderman CH, Kassam AB. The management of cerebrospinal fluid leaks in patients at risk for high-pressure hydrocephalus. Laryngoscope. 2005;115(2):205–12.PubMedCrossRefGoogle Scholar
  3. 3.
    Hasheminia D, Kalantar Motamedi MR, Hashemzehi H, Nazeri R, Movahedian B. A 7-year study of 1,278 patients with maxillofacial trauma and cerebrospinal fluid leak. J Maxillofac Oral Surg. 2015;14(2):258–62.PubMedCrossRefGoogle Scholar
  4. 4.
    Daudia A, Biswas D, Jones NS. Risk of meningitis with cerebrospinal fluid rhinorrhea. Ann Otol Rhinol Laryngol. 2007;116(12):902–5.PubMedCrossRefGoogle Scholar
  5. 5.
    Hebert-Blouin MN, Mokri B, Shin AY, Bishop AT, Spinner RJ. Cerebrospinal fluid volume-depletion headaches in patients with traumatic brachial plexus injury. J Neurosurg. 2013;118(1):149–54.PubMedCrossRefGoogle Scholar
  6. 6.
    Hegazy HM, Carrau RL, Snyderman CH, Kassam A, Zweig J. Transnasal endoscopic repair of cerebrospinal fluid rhinorrhea: a meta-analysis. Laryngoscope. 2000;110(7):1166–72.PubMedCrossRefGoogle Scholar
  7. 7.
    Martin-Martin C, Martinez-Capoccioni G, Serramito-Garcia R, Espinosa-Restrepo F. Surgical challenge: endoscopic repair of cerebrospinal fluid leak. BMC Res Notes. 2012;5:459.PubMedPubMedCentralCrossRefGoogle Scholar
  8. 8.
    Janecka IP, Sen C, Sekhar LN, et al. Cranial base surgery: results in 183 patients. Otolaryngol Head Neck Surg. 1994;110(6):539–46.PubMedCrossRefGoogle Scholar
  9. 9.
    Cammisa FP Jr, Girardi FP, Sangani PK, Parvataneni HK, Cadag S, Sandhu HS. Incidental durotomy in spine surgery. Spine (Phila Pa 1976). 2000;25(20):2663–7.CrossRefGoogle Scholar
  10. 10.
    Enders F, Ackemann A, Muller S, Kiening K, Orakcioglu B. Risk factors and management of incidental durotomy in lumbar interbody fusion surgery. Clin Spine Surg. 2018;31(3):127–31.PubMedCrossRefGoogle Scholar
  11. 11.
    Guerin P, El Fegoun AB, Obeid I, et al. Incidental durotomy during spine surgery: incidence, management and complications. A retrospective review. Injury. 2012;43(4):397–401.PubMedCrossRefGoogle Scholar
  12. 12.
    Hannallah D, Lee J, Khan M, Donaldson WF, Kang JD. Cerebrospinal fluid leaks following cervical spine surgery. J Bone Joint Surg Am. 2008;90(5):1101–5.PubMedCrossRefGoogle Scholar
  13. 13.
    Kotilainen E, Valtonen S, Carlson CA. Microsurgical treatment of lumbar disc herniation: follow-up of 237 patients. Acta Neurochir. 1993;120(3–4):143–9.PubMedCrossRefGoogle Scholar
  14. 14.
    Rampersaud YR, Moro ER, Neary MA, et al. Intraoperative adverse events and related postoperative complications in spine surgery: implications for enhancing patient safety founded on evidence-based protocols. Spine (Phila Pa 1976). 2006;31(13):1503–10.CrossRefGoogle Scholar
  15. 15.
    Saxler G, Kramer J, Barden B, Kurt A, Pfortner J, Bernsmann K. The long-term clinical sequelae of incidental durotomy in lumbar disc surgery. Spine (Phila Pa 1976). 2005;30(20):2298–302.CrossRefGoogle Scholar
  16. 16.
    Stolke D, Sollmann WP, Seifert V. Intra- and postoperative complications in lumbar disc surgery. Spine (Phila Pa 1976). 1989;14(1):56–9.CrossRefGoogle Scholar
  17. 17.
    Syre P, Bohman LE, Baltuch G, Le Roux P, Welch WC. Cerebrospinal fluid leaks and their management after anterior cervical discectomy and fusion: a report of 13 cases and a review of the literature. Spine (Phila Pa 1976). 2014;39(16):E936–43.CrossRefGoogle Scholar
  18. 18.
    Wang JC, Bohlman HH, Riew KD. Dural tears secondary to operations on the lumbar spine. Management and results after a two-year-minimum follow-up of eighty-eight patients. J Bone Joint Surg Am. 1998;80(12):1728–32.PubMedCrossRefGoogle Scholar
  19. 19.
    Gaucher DJ Jr, Perez JA Jr. Subdural hematoma following lumbar puncture. Arch Intern Med. 2002;162(16):1904–5.PubMedCrossRefGoogle Scholar
  20. 20.
    Khazim R, Dannawi Z, Spacey K, et al. Incidence and treatment of delayed symptoms of CSF leak following lumbar spinal surgery. Eur Spine J. 2015;24(9):2069–76.PubMedCrossRefGoogle Scholar
  21. 21.
    Lu CH, Ho ST, Kong SS, Cherng CH, Wong CS. Intracranial subdural hematoma after unintended durotomy during spine surgery. Can J Anaesth. 2002;49(1):100–2.PubMedCrossRefGoogle Scholar
  22. 22.
    Pham MH, Tuchman A, Platt A, Hsieh PC. Intracranial complications associated with spinal surgery. Eur Spine J. 2016;25(3):888–94.PubMedCrossRefGoogle Scholar
  23. 23.
    Sciubba DM, Kretzer RM, Wang PP. Acute intracranial subdural hematoma following a lumbar CSF leak caused by spine surgery. Spine (Phila Pa 1976). 2005;30(24):E730–2.CrossRefGoogle Scholar
  24. 24.
    Deseyne S, Vanhouteghem K, Hallaert G, Delanghe J, Malfait T. Subarachnoidal-pleural fistula (SAPF) as an unusual cause of persistent pleural effusion. Beta-trace protein as a marker for SAPF. Case report and review of the literature. Acta Clin Belg. 2015;70(1):53–7.PubMedCrossRefGoogle Scholar
  25. 25.
    Mokri B, Piepgras DG, Miller GM. Syndrome of orthostatic headaches and diffuse pachymeningeal gadolinium enhancement. Mayo Clin Proc. 1997;72(5):400–13.PubMedCrossRefGoogle Scholar
  26. 26.
    Schievink WI, Schwartz MS, Maya MM, Moser FG, Rozen TD. Lack of causal association between spontaneous intracranial hypotension and cranial cerebrospinal fluid leaks. J Neurosurg. 2012;116(4):749–54.PubMedCrossRefGoogle Scholar
  27. 27.
    Cilluffo JM, Gomez MR, Reese DF, Onofrio BM, Miller RH. Idiopathic (“ongenital”) spinal arachnoid diverticula. Clinical diagnosis and surgical results. Mayo Clin Proc. 1981;56(2):93–101.PubMedGoogle Scholar
  28. 28.
    Schievink WI, Torres VE. Spinal meningeal diverticula in autosomal dominant polycystic kidney disease. Lancet. 1997;349(9060):1223–4.PubMedCrossRefGoogle Scholar
  29. 29.
    Davenport RJ, Chataway SJ, Warlow CP. Spontaneous intracranial hypotension from a CSF leak in a patient with Marfan’s syndrome. J Neurol Neurosurg Psychiatry. 1995;59(5):516–9.PubMedPubMedCentralCrossRefGoogle Scholar
  30. 30.
    Fukutake T, Sakakibara R, Mori M, Araki M, Hattori T. Chronic intractable headache in a patient with Marfan’s syndrome. Headache. 1997;37(5):291–5.PubMedCrossRefGoogle Scholar
  31. 31.
    Schrijver I, Schievink WI, Godfrey M, Meyer FB, Francke U. Spontaneous spinal cerebrospinal fluid leaks and minor skeletal features of Marfan syndrome: a microfibrillopathy. J Neurosurg. 2002;96(3):483–9.PubMedCrossRefGoogle Scholar
  32. 32.
    Fattori R, Nienaber CA, Descovich B, et al. Importance of dural ectasia in phenotypic assessment of Marfan’s syndrome. Lancet. 1999;354(9182):910–3.PubMedCrossRefGoogle Scholar
  33. 33.
    Vishteh AG, Schievink WI, Baskin JJ, Sonntag VK. Cervical bone spur presenting with spontaneous intracranial hypotension. Case report. J Neurosurg. 1998;89(3):483–4.PubMedCrossRefGoogle Scholar
  34. 34.
    Winter SC, Maartens NF, Anslow P, Teddy PJ. Spontaneous intracranial hypotension due to thoracic disc herniation. Case report. J Neurosurg. 2002;96(3 Suppl):343–5.PubMedPubMedCentralGoogle Scholar
  35. 35.
    Mokri B. Spontaneous CSF leaks: low CSF volume syndromes. Neurol Clin. 2014;32(2):397–422.PubMedCrossRefGoogle Scholar
  36. 36.
    Horton JC, Fishman RA. Neurovisual findings in the syndrome of spontaneous intracranial hypotension from dural cerebrospinal fluid leak. Ophthalmology. 1994;101(2):244–51.PubMedCrossRefPubMedCentralGoogle Scholar
  37. 37.
    Evan RW, Mokri B. Spontaneous intracranial hypotension resulting in coma. Headache. 2002;42(2):159–60.PubMedCrossRefGoogle Scholar
  38. 38.
    Beck CE, Rizk NW, Kiger LT, Spencer D, Hill L, Adler JR. Intracranial hypotension presenting with severe encephalopathy. Case report. J Neurosurg. 1998;89(3):470–3.PubMedCrossRefPubMedCentralGoogle Scholar
  39. 39.
    de Noronha RJ, Sharrack B, Hadjivassiliou M, Romanowski CA. Subdural haematoma: a potentially serious consequence of spontaneous intracranial hypotension. J Neurol Neurosurg Psychiatry. 2003;74(6):752–5.PubMedPubMedCentralCrossRefGoogle Scholar
  40. 40.
    Mizuno J, Mummaneni PV, Rodts GE, Barrow DL. Recurrent subdural hematoma caused by cerebrospinal fluid leakage. Case report. J Neurosurg Spine. 2006;4(2):183–5.PubMedCrossRefGoogle Scholar
  41. 41.
    Berroir S, Grabli D, Heran F, Bakouche P, Bousser MG. Cerebral sinus venous thrombosis in two patients with spontaneous intracranial hypotension. Cerebrovasc Dis. 2004;17(1):9–12.PubMedCrossRefGoogle Scholar
  42. 42.
    Deluca GC, Boes CJ, Krueger BR, Mokri B, Kumar N. Ventral intraspinal fluid-filled collection secondary to CSF leak presenting as bibrachial amyotrophy. Neurology. 2011;76(16):1439–40.PubMedCrossRefGoogle Scholar
  43. 43.
    Mokri B. Intracranial hypertension after treatment of spontaneous cerebrospinal fluid leaks. Mayo Clin Proc. 2002;77(11):1241–6.PubMedCrossRefGoogle Scholar
  44. 44.
    Headache Classification Committee of the International Headache Society. The international classification of headache disorders, 3rd edition (beta version). Cephalalgia. 2013;33(9):629–808.CrossRefGoogle Scholar
  45. 45.
    Kranz PG, Tanpitukpongse TP, Choudhury KR, Amrhein TJ, Gray L. How common is normal cerebrospinal fluid pressure in spontaneous intracranial hypotension? Cephalalgia. 2016;36(13):1209–17.PubMedCrossRefGoogle Scholar
  46. 46.
    Mokri B, Hunter SF, Atkinson JL, Piepgras DG. Orthostatic headaches caused by CSF leak but with normal CSF pressures. Neurology. 1998;51(3):786–90.PubMedCrossRefGoogle Scholar
  47. 47.
    Miyazawa K, Shiga Y, Hasegawa T, et al. CSF hypovolemia vs intracranial hypotension in “spontaneous intracranial hypotension syndrome”. Neurology. 2003;60(6):941–7.PubMedCrossRefGoogle Scholar
  48. 48.
    Yaffe D, Gordon CR. Noncontrast brain computed tomography findings of spontaneous intracranial hypotension in the emergency department setting. J Emerg Med. 2016;50(4):588–93.PubMedCrossRefGoogle Scholar
  49. 49.
    Shetty PG, Shroff MM, Fatterpekar GM, Sahani DV, Kirtane MV. A retrospective analysis of spontaneous sphenoid sinus fistula: MR and CT findings. AJNR Am J Neuroradiol. 2000;21(2):337–42.PubMedGoogle Scholar
  50. 50.
    Schlosser RJ, Bolger WE. Nasal cerebrospinal fluid leaks: critical review and surgical considerations. Laryngoscope. 2004;114(2):255–65.PubMedCrossRefGoogle Scholar
  51. 51.
    Smirniotopoulos JG, Murphy FM, Rushing EJ, Rees JH, Schroeder JW. Patterns of contrast enhancement in the brain and meninges. Radiographics. 2007;27(2):525–51.PubMedPubMedCentralCrossRefGoogle Scholar
  52. 52.
    Farb RI, Forghani R, Lee SK, Mikulis DJ, Agid R. The venous distension sign: a diagnostic sign of intracranial hypotension at MR imaging of the brain. AJNR Am J Neuroradiol. 2007;28(8):1489–93.PubMedCrossRefGoogle Scholar
  53. 53.
    Alvarez-Linera J, Escribano J, Benito-Leon J, Porta-Etessam J, Rovira A. Pituitary enlargement in patients with intracranial hypotension syndrome. Neurology. 2000;55(12):1895–7.PubMedCrossRefGoogle Scholar
  54. 54.
    Atkinson JL, Weinshenker BG, Miller GM, Piepgras DG, Mokri B. Acquired Chiari I malformation secondary to spontaneous spinal cerebrospinal fluid leakage and chronic intracranial hypotension syndrome in seven cases. J Neurosurg. 1998;88(2):237–42.PubMedCrossRefGoogle Scholar
  55. 55.
    Savoiardo M, Minati L, Farina L, et al. Spontaneous intracranial hypotension with deep brain swelling. Brain. 2007;130(Pt 7):1884–93.PubMedCrossRefGoogle Scholar
  56. 56.
    Shah LM, McLean LA, Heilbrun ME, Salzman KL. Intracranial hypotension: improved MRI detection with diagnostic intracranial angles. AJR Am J Roentgenol. 2013;200(2):400–7.PubMedCrossRefGoogle Scholar
  57. 57.
    Silver RI, Moonis G, Schlosser RJ, Bolger WE, Loevner LA. Radiographic signs of elevated intracranial pressure in idiopathic cerebrospinal fluid leaks: a possible presentation of idiopathic intracranial hypertension. Am J Rhinol. 2007;21(3):257–61.PubMedCrossRefGoogle Scholar
  58. 58.
    Schlosser RJ, Bolger WE. Spontaneous nasal cerebrospinal fluid leaks and empty sella syndrome: a clinical association. Am J Rhinol. 2003;17(2):91–6.PubMedCrossRefGoogle Scholar
  59. 59.
    Chaaban MR, Illing E, Riley KO, Woodworth BA. Spontaneous cerebrospinal fluid leak repair: a five-year prospective evaluation. Laryngoscope. 2014;124(1):70–5.PubMedCrossRefGoogle Scholar
  60. 60.
    Zagardo MT, Cail WS, Kelman SE, Rothman MI. Reversible empty sella in idiopathic intracranial hypertension: an indicator of successful therapy? AJNR Am J Neuroradiol. 1996;17(10):1953–6.PubMedGoogle Scholar
  61. 61.
    Teachey W, Grayson J, Cho DY, Riley KO, Woodworth BA. Intervention for elevated intracranial pressure improves success rate after repair of spontaneous cerebrospinal fluid leaks. Laryngoscope. 2017;127(9):2011–6.PubMedCrossRefGoogle Scholar
  62. 62.
    Medina JH, Abrams K, Falcone S, Bhatia RG. Spinal imaging findings in spontaneous intracranial hypotension. AJR Am J Roentgenol. 2010;195(2):459–64.PubMedCrossRefGoogle Scholar
  63. 63.
    Morgan JT, Scumpia AJ, Johnson AA, Schneider SJ. Case report: spontaneous intracranial hypotension in association with the presence of a false localizing C1-C2 cerebrospinal fluid leak. Surg Neurol. 2008;70(5):539–43; discussion 543–4PubMedCrossRefGoogle Scholar
  64. 64.
    Schievink WI, Maya MM, Tourje J. False localizing sign of C1-2 cerebrospinal fluid leak in spontaneous intracranial hypotension. J Neurosurg. 2004;100(4):639–44.PubMedCrossRefGoogle Scholar
  65. 65.
    Yousry I, Forderreuther S, Moriggl B, et al. Cervical MR imaging in postural headache: MR signs and pathophysiological implications. AJNR Am J Neuroradiol. 2001;22(7):1239–50.PubMedGoogle Scholar
  66. 66.
    Kranz PG, Luetmer PH, Diehn FE, Amrhein TJ, Tanpitukpongse TP, Gray L. Myelographic techniques for the detection of spinal CSF leaks in spontaneous intracranial hypotension. AJR Am J Roentgenol. 2016;206(1):8–19.PubMedCrossRefGoogle Scholar
  67. 67.
    Starling A, Hernandez F, Hoxworth JM, et al. Sensitivity of MRI of the spine compared with CT myelography in orthostatic headache with CSF leak. Neurology. 2013;81(20):1789–92.PubMedCrossRefGoogle Scholar
  68. 68.
    Tsai PH, Fuh JL, Lirng JF, Wang SJ. Heavily T2-weighted MR myelography in patients with spontaneous intracranial hypotension: a case-control study. Cephalalgia. 2007;27(8):929–34.PubMedCrossRefGoogle Scholar
  69. 69.
    Wang YF, Lirng JF, Fuh JL, Hseu SS, Wang SJ. Heavily T2-weighted MR myelography vs CT myelography in spontaneous intracranial hypotension. Neurology. 2009;73(22):1892–8.PubMedCrossRefGoogle Scholar
  70. 70.
    Mokri B. Spontaneous intracranial hypotension. Continuum (Minneap Minn). 2015;21(4 Headache):1086–108.Google Scholar
  71. 71.
    Wendl CM, Schambach F, Zimmer C, Forschler A. CT myelography for the planning and guidance of targeted epidural blood patches in patients with persistent spinal CSF leakage. AJNR Am J Neuroradiol. 2012;33(3):541–4.PubMedCrossRefGoogle Scholar
  72. 72.
    Luetmer PH, Mokri B. Dynamic CT myelography: a technique for localizing high-flow spinal cerebrospinal fluid leaks. AJNR Am J Neuroradiol. 2003;24(8):1711–4.PubMedGoogle Scholar
  73. 73.
    Thielen KR, Sillery JC, Morris JM, et al. Ultrafast dynamic computed tomography myelography for the precise identification of high-flow cerebrospinal fluid leaks caused by spiculated spinal osteophytes. J Neurosurg Spine. 2015;22(3):324–31.PubMedCrossRefGoogle Scholar
  74. 74.
    Hoxworth JM, Patel AC, Bosch EP, Nelson KD. Localization of a rapid CSF leak with digital subtraction myelography. AJNR Am J Neuroradiol. 2009;30(3):516–9.PubMedCrossRefGoogle Scholar
  75. 75.
    Hoxworth JM, Trentman TL, Kotsenas AL, Thielen KR, Nelson KD, Dodick DW. The role of digital subtraction myelography in the diagnosis and localization of spontaneous spinal CSF leaks. AJR Am J Roentgenol. 2012;199(3):649–53.PubMedCrossRefGoogle Scholar
  76. 76.
    Schievink WI, Moser FG, Maya MM, Prasad RS. Digital subtraction myelography for the identification of spontaneous spinal CSF-venous fistulas. J Neurosurg Spine. 2016;24(6):960–4.PubMedCrossRefGoogle Scholar
  77. 77.
    Mokri B. Radioisotope cisternography in spontaneous CSF leaks: interpretations and misinterpretations. Headache. 2014;54(8):1358–68.PubMedCrossRefGoogle Scholar
  78. 78.
    Molins A, Alvarez J, Sumalla J, Titus F, Codina A. Cisternographic pattern of spontaneous liquoral hypotension. Cephalalgia. 1990;10(2):59–65.PubMedCrossRefGoogle Scholar
  79. 79.
    Monteith TS, Kralik SF, Dillon WP, Hawkins RA, Goadsby PJ. The utility of radioisotope cisternography in low CSF/volume syndromes compared to myelography. Cephalalgia. 2016;36(13):1291–5.PubMedCrossRefGoogle Scholar
  80. 80.
    Akbar JJ, Luetmer PH, Schwartz KM, Hunt CH, Diehn FE, Eckel LJ. The role of MR myelography with intrathecal gadolinium in localization of spinal CSF leaks in patients with spontaneous intracranial hypotension. AJNR Am J Neuroradiol. 2012;33(3):535–40.PubMedCrossRefGoogle Scholar
  81. 81.
    Albayram S, Kilic F, Ozer H, Baghaki S, Kocer N, Islak C. Gadolinium-enhanced MR cisternography to evaluate dural leaks in intracranial hypotension syndrome. AJNR Am J Neuroradiol. 2008;29(1):116–21.PubMedCrossRefGoogle Scholar
  82. 82.
    Arlt S, Cepek L, Rustenbeck HH, Prange H, Reimers CD. Gadolinium encephalopathy due to accidental intrathecal administration of gadopentetate dimeglumine. J Neurol. 2007;254(6):810–2.PubMedCrossRefGoogle Scholar
  83. 83.
    Li L, Gao FQ, Zhang B, Luo BN, Yang ZY, Zhao J. Overdosage of intrathecal gadolinium and neurological response. Clin Radiol. 2008;63(9):1063–8.PubMedCrossRefGoogle Scholar
  84. 84.
    Kerr JT, Chu FW, Bayles SW. Cerebrospinal fluid rhinorrhea: diagnosis and management. Otolaryngol Clin N Am. 2005;38(4):597–611.CrossRefGoogle Scholar
  85. 85.
    Friedman JA, Ebersold MJ, Quast LM. Persistent posttraumatic cerebrospinal fluid leakage. Neurosurg Focus. 2000;9(1):e1.PubMedCrossRefGoogle Scholar
  86. 86.
    Savva A, Taylor MJ, Beatty CW. Management of cerebrospinal fluid leaks involving the temporal bone: report on 92 patients. Laryngoscope. 2003;113(1):50–6.PubMedCrossRefGoogle Scholar
  87. 87.
    Bell RB, Dierks EJ, Homer L, Potter BE. Management of cerebrospinal fluid leak associated with craniomaxillofacial trauma. J Oral Maxillofac Surg. 2004;62(6):676–84.PubMedCrossRefGoogle Scholar
  88. 88.
    Yeo NK, Cho GS, Kim CJ, et al. The effectiveness of lumbar drainage in the conservative and surgical treatment of traumatic cerebrospinal fluid rhinorrhea. Acta Otolaryngol. 2013;133(1):82–90.PubMedCrossRefGoogle Scholar
  89. 89.
    Yilmazlar S, Arslan E, Kocaeli H, et al. Cerebrospinal fluid leakage complicating skull base fractures: analysis of 81 cases. Neurosurg Rev. 2006;29(1):64–71.PubMedPubMedCentralCrossRefGoogle Scholar
  90. 90.
    Ratilal BO, Costa J, Pappamikail L, Sampaio C. Antibiotic prophylaxis for preventing meningitis in patients with basilar skull fractures. Cochrane Database Syst Rev. 2015;(4):CD004884.Google Scholar
  91. 91.
    Albu S, Emanuelli E, Trombitas V, Florian IS. Effectiveness of lumbar drains on recurrence rates in endoscopic surgery of cerebrospinal fluid leaks. Am J Rhinol Allergy. 2013;27(6):e190–4.PubMedCrossRefGoogle Scholar
  92. 92.
    Brodie HA, Thompson TC. Management of complications from 820 temporal bone fractures. Am J Otol. 1997;18(2):188–97.PubMedGoogle Scholar
  93. 93.
    Schoentgen C, Henaux PL, Godey B, Jegoux F. Management of post-traumatic cerebrospinal fluid (CSF) leak of anterior skull base: 10 years experience. Acta Otolaryngol. 2013;133(9):944–50.PubMedCrossRefGoogle Scholar
  94. 94.
    Virk JS, Elmiyeh B, Saleh HA. Endoscopic management of cerebrospinal fluid rhinorrhea: the charing cross experience. J Neurol Surg B Skull Base. 2013;74(2):61–7.PubMedPubMedCentralCrossRefGoogle Scholar
  95. 95.
    Stankiewicz JA. Complications of endoscopic intranasal ethmoidectomy. Laryngoscope. 1987;97(11):1270–3.PubMedCrossRefGoogle Scholar
  96. 96.
    Kassam AB, Thomas A, Carrau RL, et al. Endoscopic reconstruction of the cranial base using a pedicled nasoseptal flap. Neurosurgery. 2008;63(1 Suppl 1):ONS44–52; discussion ONS52–43Google Scholar
  97. 97.
    Fraser S, Gardner PA, Koutourousiou M, et al. Risk factors associated with postoperative cerebrospinal fluid leak after endoscopic endonasal skull base surgery. J Neurosurg. 2018;128(4):1066–71.PubMedCrossRefGoogle Scholar
  98. 98.
    Hadad G, Bassagasteguy L, Carrau RL, et al. A novel reconstructive technique after endoscopic expanded endonasal approaches: vascular pedicle nasoseptal flap. Laryngoscope. 2006;116(10):1882–6.PubMedCrossRefGoogle Scholar
  99. 99.
    Paluzzi A, Fernandez-Miranda JC, Tonya Stefko S, Challinor S, Snyderman CH, Gardner PA. Endoscopic endonasal approach for pituitary adenomas: a series of 555 patients. Pituitary. 2014;17(4):307–19.PubMedCrossRefGoogle Scholar
  100. 100.
    Tosun B, Ilbay K, Kim MS, Selek O. Management of persistent cerebrospinal fluid leakage following thoraco-lumbar surgery. Asian Spine J. 2012;6(3):157–62.PubMedPubMedCentralCrossRefGoogle Scholar
  101. 101.
    Kitchel SH, Eismont FJ, Green BA. Closed subarachnoid drainage for management of cerebrospinal fluid leakage after an operation on the spine. J Bone Joint Surg Am. 1989;71(7):984–7.PubMedCrossRefGoogle Scholar
  102. 102.
    Eismont FJ, Wiesel SW, Rothman RH. Treatment of dural tears associated with spinal surgery. J Bone Joint Surg Am. 1981;63(7):1132–6.PubMedCrossRefGoogle Scholar
  103. 103.
    Mokri B, Maher CO, Sencakova D. Spontaneous CSF leaks: underlying disorder of connective tissue. Neurology. 2002;58(5):814–6.PubMedCrossRefGoogle Scholar
  104. 104.
    Oberascher G, Arrer E. Efficiency of various methods of identifying cerebrospinal fluid in oto- and rhinorrhea. ORL J Otorhinolaryngol Relat Spec. 1986;48(6):320–5.PubMedCrossRefGoogle Scholar
  105. 105.
    Fransen P, Sindic CJ, Thauvoy C, Laterre C, Stroobandt G. Highly sensitive detection of beta-2 transferrin in rhinorrhea and otorrhea as a marker for cerebrospinal fluid (C.S.F.) leakage. Acta Neurochir (Wien). 1991;109(3–4):98–101.CrossRefGoogle Scholar
  106. 106.
    Skedros DG, Cass SP, Hirsch BE, Kelly RH. Sources of error in use of beta-2 transferrin analysis for diagnosing perilymphatic and cerebral spinal fluid leaks. Otolaryngol Head Neck Surg. 1993;109(5):861–4.PubMedCrossRefGoogle Scholar
  107. 107.
    Adams AS, Russell PT, Duncavage JA, Chandra RK, Turner JH. Outcomes of endoscopic repair of cerebrospinal fluid rhinorrhea without lumbar drains. Am J Rhinol Allergy. 2016;30(6):424–9.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  • David L. DornbosIII
    • 1
  • Nathaniel Toop
    • 1
  • Ammar Shaikhouni
    • 1
  • H. Wayne Slone
    • 2
  • John M. McGregor
    • 1
    Email author
  1. 1.Department of Neurological SurgeryThe Ohio State University Wexner Medical CenterColumbusUSA
  2. 2.Department of RadiologyThe Ohio State University Wexner Medical CenterColumbusUSA

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