Spontaneous CSF leaks are a rare entity. In this paper, a Spanish group report their experience managing the condition using endoscopic surgery in 35 patients over an eight year period. Leak locations included the cribriform plate (18/35), ethmoid roof (15/35) and the lateral recess of the sphenoid sinus (2/35). The authors used a three-layer closure including a vascularised nasoseptal flap for defects larger than 5mm and a two-layer closure if less than 5mm. All patients had a lumbar drain inserted at the time of surgery for a period of 72 hours. Finally, all patients received oral acetazolamide for 6-8 months and seven days of prophylactic antibiotics postoperatively. The group had an impressive 97% (34/35) successful repair rate. The key learning point from the paper is the fastidious management of the raised intracranial pressure using the techniques above. Repair of spontaneous CSF leaks can have a low success rate if this is not taken into account.

Spontaneous cerebrospinal fluid leaks in the anterior skull base secondary to idiopathic intracranial hypertension. Martinez-Capoccioni G, Serramito-Garcia R, Martin-Bailon M, Garcia-Allut A, Martin-Martin C.
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Sidhartha Nagala

Royal Hallamshire Hospital, Sheffield, UK.

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