Treatment of Cerebrospinal Fluid Leaks in High-Risk Patients

Background: Although the surgical literature recommends vascularized tissue for repair of cerebrospinal fluid (CSF) leaks, closure has been successful using autogenous nonvascularized grafts at our institution. High-risk patients were defined as those with CSF leaks and at least 2 of the following: (1) failed attempt at repair, (2) previous radiation, (3) infection, and (4) osteotmyelitis/osteonecrosis of bone flap. Methods: Data were collected regarding primacy diagnosis, adjuvant radiotherapy, infection, previous attempts at closure, related hospitalizations, admissions before and after repair. Results: The CSF leaks of 12 of 14 high-risk patients were successfully closed at a single operation. Discussion: Patients with complex CSF leaks can be closed following these principles: (1) expose and identify the dural edges. This often requires resection of native cranial bone. (2) If osteomyelitis is suspected, the bone flap is discarded and skin closed over dura. (3) Dead space is avoided. If the previously mentioned principles are followed, free tissue transfers can often be avoided.