Meningitis is the most feared and severe complication of a CSF leak. Bacterial meningitis is typically due to Streptococcus pneumoniae and Haemophilus influenzae. The risk of meningitis during the first 3 weeks after trauma is estimated to be 10%. The rate increases to 40% in nontraumatic CSF rhinorrhea.
Some studies have reported that conservative management using bed rest and lumbar drains is associated with a high incidence of ascending meningitis. Thus, prompt surgical closure of a CSF leak is advocated by some authors. Meningitis caused by a persistent CSF leak is associated with a high mortality rate.
Only a small percentage (< 1%) of patients develop new meningitis after surgical closure. Not all cases of postoperative meningitis are due to the aforementioned bacteria. Some patients may develop aseptic meningitis due to meningeal irritation as a result of manipulation during surgical repair.
The surgical mortality rate is 1-3% for intracranial procedures and is negligible for external procedures. Anosmia is the main contributor to morbidity for intracranial approaches, occurring in 20-25% of the cases.
-
An axial CT of a patient with a spontaneous CSF leak reveals a defect in the posterior table of the left frontal sinus.
-
After intrathecal fluorescein is administered, an exposed frontal recess encephalocele is seen.
-
A defect in the skull base is measured with a sterile ruler.
-
A small cribriform plate encephalocele is observed only after removing the middle turbinate.
-
Septal bone is used as an underlay graft in the repair of this skull base defect in a patient with a spontaneous leak and encephalocele. (Defect measured approximately 7mm.)
-
Triplanar images help to identify and conceptualize the location of this lateral recess encephalocele.
-
This image represents an endoscopic view with a 70-degree telescope through the left frontal recess. A large defect is noted, and the meningocele has been resected. Repair of the leak can be performed with an underlay fascia graft and an anterior-based pedicled mucosa flap.
-
Triplanar images of a patient with a left lateral recess meningoencephalocele. The probe indicates that access to the defect is performed through the maxillary sinus and pterygopalatine fossa.