Cerebrospinal fluid fistulae: Management experience in sub-Saharan Africa

Background: Cerebrospinal fluid (CSF) fistula is an important neurosurgical problem, which can present difficult challenges to the neurosurgeon, particularly in resource poor environments 'such as sub Saharan Africa. Method: This is a review of the aetiology and management of CSF fistulae based on experience in northern Nigeria in an 8 year period. Results: A total of 30 patients were managed. Most patients presented after a considerable delay, largely due to limited access to a neurosurgical service. The causes were posttraumatic 10, postoperative 18, and spontaneous 2. The modes of presentation were widely varied ranging from otorrhea, rhinorrhea and CSF leakage from operation sites. Diagnostic evaluation was frequently made difficult by limited facilities. Our treatment modalities included use of broad-spectrum antibiotics, non-operative and operative treatments respectively. Details of the treatment and outcome are discussed. Conclusion: Management of CSF fistulae can be challenging, particularly in the absence of adequate facilities. The paucity of trained neurosurgeons in our environment