Cerebrospinal Fluid Leak

Discharge of cerebrospinal fluid through a hole through the skull bone most commonly draining from the nose (CEREBROSPINAL FLUID RHINORRHEA) or the ear (CEREBROSPINAL FLUID OTORRHEA).

Also Known As:

Cerebrospinal Fluid Drainage; Cerebrospinal Fluid Drainage, Post-Traumatic; Cerebrospinal Fluid Drainage, Spontaneous; Cerebrospinal Fluid Drainage, Traumatic; Cerebrospinal Fluid Leak, Post-Traumatic; Cerebrospinal Fluid Leak, Spontaneous; Cerebrospinal Fluid Leak, Traumatic; Cerebrospinal Fluid Leakage; Cerebrospinal Fluid Leakage, Post-Traumatic; Cerebrospinal Fluid Leakage, Spontaneous; Cerebrospinal Fluid Leakage, Traumatic; Spinal Cerebrospinal Fluid Leak; Spinal Cerebrospinal Fluid Leak, Post-Traumatic; Spinal Cerebrospinal Fluid Leak, Spontaneous; Spinal Cerebrospinal Fluid Leak, Traumatic; Cerebrospinal Fluid Drainage, Post Traumatic; Cerebrospinal Fluid Drainages; Cerebrospinal Fluid Leak, Post Traumatic; Cerebrospinal Fluid Leakage, Post Traumatic; Cerebrospinal Fluid Leakages; Cerebrospinal Fluid Leaks; Drainage, Cerebrospinal Fluid; Drainages, Cerebrospinal Fluid; Fluid Drainage, Cerebrospinal; Fluid Drainages, Cerebrospinal; Fluid Leak, Cerebrospinal; Fluid Leakage, Cerebrospinal; Fluid Leakages, Cerebrospinal; Fluid Leaks, Cerebrospinal; Leak, Cerebrospinal Fluid; Leakage, Cerebrospinal Fluid; Leakages, Cerebrospinal Fluid; Leaks, Cerebrospinal Fluid; Spinal Cerebrospinal Fluid Leak, Post Traumatic

Networked: 1347 relevant articles (53 outcomes, 37 trials/studies)

Relationship Network

Disease Context: Research Results

Related Diseases

1.	Infections
2.	Meningitis
3.	Hemorrhage
4.	Hyperventilation
5.	Craniocerebral Trauma (Head Injury)

Experts

1.	Coselli, Joseph S: 10 articles (08/2021 - 11/2002)
2.	Snyderman, Carl H: 7 articles (04/2022 - 10/2006)
3.	LeMaire, Scott A: 7 articles (08/2016 - 11/2002)
4.	Gardner, Paul A: 6 articles (04/2022 - 12/2012)
5.	Schlosser, Rodney J: 6 articles (11/2017 - 01/2005)
6.	Bydon, Ali: 5 articles (01/2022 - 03/2008)
7.	Samy, Ravi N: 5 articles (01/2021 - 03/2009)
8.	Fernandez-Miranda, Juan C: 5 articles (01/2020 - 12/2012)
9.	Liu, Gang: 4 articles (05/2022 - 12/2012)
10.	Sciubba, Daniel M: 4 articles (01/2022 - 03/2008)

Drugs and Biologics

Drugs and Important Biological Agents (IBA) related to Cerebrospinal Fluid Leak:

1.	Anti-Bacterial Agents (Antibiotics)IBA 06/01/2018 - "Current procedural terminology coding and antibiotic regimens were widely divergent; 31.4% never placed lumbar drains preoperatively, while 41.4% did so for anticipated high-flow cerebrospinal fluid leaks. " 03/01/2017 - "Our patient presented with a traumatic cerebrospinal fluid leak, and recovered well after transorbital and endoscopic removal of the branch, skull base repair, and a prolonged course of antibiotics and antifungal medications. " 01/01/2017 - "General considerations, such as securing the airway, leaving the penetrating arrow in the neck and immobilizing both the arrow and neck for transport, thorough diagnostic imaging, preventing cerebrospinal fluid leakage, administering prophylactic antibiotics with broad coverage and stabilizing the spine if required, are advised." 07/01/2014 - "Of those who responded to the survey, 14 per cent routinely give prophylactic antibiotics to patients with cerebrospinal fluid leaks, and 34.9 per cent recommend immunisation against at least one organism, most commonly Streptococcus pneumoniae (86.7 per cent). " 07/01/2014 - "There are no UK guidelines for the use of antibiotics and/or immunisations in patients with an active anterior skull base cerebrospinal fluid leak. "
2.	Fibrin Tissue Adhesive (Fibrin Sealant)IBA 07/01/2001 - "The sealing effect of fibrin sealant on cerebrospinal fluid leakage was significantly greater with the rubbing method than with the spray method. " 07/01/2020 - "The aim of this study was to assess the surgical outcomes of endoscopic transnasal cerebrospinal fluid leak repair with and without fibrin glue. " 01/01/2016 - "Other clinical trials evaluated the effect of fibrin sealant in the postoperative prevention of cerebrospinal fluid leaks. " 08/01/2000 - "The objective of this study is to assess CT-guided percutaneous injection of fibrin glue for the management of cerebrospinal fluid leaks within the spine. " 11/01/1999 - "In this study, fibrin sealant (ViGuard Fibrin Sealant was used to adhere muscle grafts to surgically created dural defects to close cerebrospinal fluid leaks in chinchillas. "
3.	Mannitol (Osmitrol)FDA LinkGeneric 05/26/2022 - "The patient woke up on the 1st d after the operation and was given 50 g of 20% mannitol intravenously every 8 h without cerebrospinal fluid drainage. " 10/01/1999 - "There was no difference between frequency of use of hyperventilation, mannitol, cerebrospinal fluid drainage, and vasopressors between the two groups. " 10/01/1999 - "This study was a secondary analysis, conducted within a National Institutes of Health clinical trial on the efficacy of therapeutic hypothermia, to determine the effects of therapeutic hypothermia on ICP and of interventions (i.e., cerebrospinal fluid drainage and mannitol administration) on intracranial hypertension. " 10/01/1995 - "Neuroanesthesia adjunct therapy (mannitol and hyperventilation) is as effective as cerebrospinal fluid drainage for prevention of paraplegia after descending thoracic aortic cross-clamping in the dog." 12/01/1995 - "Therapies to lower intracranial pressure (ICP) after traumatic brain injury (TBI) include hyperventilation (HV), intravenous mannitol (IM), and cerebrospinal fluid drainage from a ventriculostomy (DV). "
4.	FibrinIBA 01/01/2016 - "Evidence from non-randomized, controlled trials suggests that fibrin sealants may be effective in preventing cerebrospinal fluid leaks with an acceptable safety profile. " 01/01/2016 - "A major finding of this systematic literature review is that there is a paucity of randomized studies that have evaluated the effectiveness and safety of fibrin sealants in providing intraoperative watertight dura closure and post-operative cerebrospinal fluid leakage. " 01/01/2016 - "Two small case series studies evaluated the effect of fibrin sealants in persistent cerebrospinal fluid leak treatment, but did not establish firm efficacy conclusions. " 01/01/2020 - "Fibrin sealants have been used for hemostasis, sealant for cerebrospinal fluid leakage, and adhesive barrier in neurosurgery. " 01/01/2016 - "The aim of this systematic review is to summarize the current efficacy and safety literature of fibrin sealants in dura sealing and the prevention/treatment of cerebrospinal fluid leaks. "
5.	Furosemide (Lasix)FDA LinkGeneric 09/01/1989 - "Under continuous lumbar cerebrospinal fluid drainage and administration of steroids, furosemide, and acetazolamide, both patients had significantly improved vision and ocular movement. " 05/02/1988 - "The monitoring of intracranial pressure and the control of increased intracranial pressure by hyperventilation, cerebrospinal-fluid drainage and mannitol, frusemide and barbiturate therapy appear to improve the outcome after a severe head injury, although this has not been proved by randomized controlled studies."
6.	SteroidsIBA 09/13/2021 - "Treatment with continuous cerebrospinal fluid drainage (CSFD), pulse steroids, and mean arterial pressure augmentation was applied, with subsequent considerable and consistent neurological improvement. " 01/01/2018 - "Although no specific cerebrospinal fluid leak was identified, the patient was suspected of having SIH and her symptoms completely reversed after a 2-month course of steroids. " 01/01/2014 - "A patient was treated with 2 EDBPs for a presumptive cerebrospinal fluid leak 3 weeks after an epidural steroid injection. " 11/01/2002 - "Resection included the proximal descending aorta in 32, the distal aortic arch in 10, extension to the diaphragm in 10, and involved a thoracoabdominal procedure in 3. Surgical techniques included hypothermic circulatory arrest (16 [47%]), distal bypass, monitoring of somatosensory-evoked potentials, sequential intercostal sacrifice (average, 5.6 pairs), cerebrospinal fluid drainage, and steroid administration. " 01/01/1990 - "Dogs were randomized into three groups: group 1 (n = 6), control; group 2 (n = 7), steroids; and group 3 (n = 6), steroids with cerebrospinal fluid drainage. "
7.	Oxygen (Dioxygen)IBA 01/01/2018 - "While the known patients with OSA were more likely to require postoperative supplemental oxygen (odds ratio [OR], 4.29; 95% confidence interval [CI], 2.38-7.75; P < .001), there was no increased risk of serious respiratory events or cerebrospinal fluid leak (CSF). " 10/01/2000 - "Arterial and jugular venous oxygen content was measured before and after cerebrospinal fluid drainage. " 11/05/2022 - "This included cerebrospinal fluid drainage (CSFD), medical therapy, and optimization of spinal cord oxygen delivery. " 01/01/2018 - "Rescue therapies include optimization of spinal cord perfusion and oxygen delivery by mean arterial pressure augmentation (> 90 mm Hg), cerebrospinal fluid drainage, and preservation of adequate haemoglobin concentration (> 100 g L⁻¹). " 03/01/2015 - "In an attempt to reduce its incidence two peri-procedural changes were implemented by the authors in January 2010: (i) all large sheaths are withdrawn from the iliac arteries immediately after deploying the central device and before cannulation and branch extension to the visceral vessels; (ii) the peri-operative protocol has been modified in an attempt to optimize oxygen delivery to the sensitive cells of the cord (aggressive blood and platelet transfusion, median arterial pressure monitoring >85 mmHg, and systematic cerebrospinal fluid drainage). "
8.	Acetazolamide (Diamox)FDA LinkGeneric 10/01/2015 - "Recent advances in epidemiology, imaging, and treatment have provided a better understanding of IIH in recent years, with better identification of visual risk factors and atypical forms of IIH, including fulminant IIH and spontaneous cerebrospinal fluid leaks, and a randomized clinical trial providing the rationale for the use of acetazolamide. " 09/01/2013 - "Acetazolamide for high intracranial pressure cerebrospinal fluid leaks." 08/07/2013 - "Analysing the effect of early acetazolamide administration on patients with a high risk of permanent cerebrospinal fluid leakage." 02/01/2008 - "All the patients were treated simply by external lumbar cerebrospinal fluid drainage with a mean volume of 10 ml/h for 3-5 days, with hypocaloric diet and with appropriate dosages of acetazolamide. " 01/01/2015 - "In this case, management with acetazolamide and suture of the fistula inhibits cerebrospinal fluid leakage without blood patch."
9.	Durapatite (Hydroxylapatite)IBA 01/01/2023 - "Efficacy of hydroxyapatite-based skull base reconstruction for intraoperative high-flow cerebrospinal fluid leakage performed by less-experienced surgeons." 11/01/2002 - "Complications of hydroxyapatite use for transnasal closure of cerebrospinal fluid leaks." 02/01/1999 - "Using hydroxylapatite ceramic buttons covered with periosteum to prevent cerebrospinal fluid leakage: technical note." 12/01/2010 - "Repair of cerebrospinal fluid leak via petrous bone using multilayer technique with hydroxyapatite paste." 08/01/1999 - "Hydroxyapatite bone cement seems to be a simple and effective method for frontal sinus obliteration and prevention of cerebrospinal fluid leakage."
10.	Vancomycin FDA LinkGeneric 04/01/2021 - "Influence of cerebrospinal fluid drainage and other variables on the plasma vancomycin trough levels in postoperative neurosurgical patients." 08/01/2023 - "Based on these identified predictors, a risk score for deep SSI incidence was created: the A-DOUBLE-SSI (Age, D [Diabetes, Drainage], O [duration of Operation, vancOmycin], albUmin, B [BMI, Blood loss], cerebrospinal fluid Leakage, Early activities, Steroid use, and Segmental Instrumentation) risk score. " 08/01/2023 - "Moreover, 12 variables were identified in the clinical knowledge-driven model, including age, BMI, diabetes, steroid use, albumin, duration of operation, blood loss, instrumented segments, powdered vancomycin administration, duration of drainage, postoperative cerebrospinal fluid leakage, and early postoperative activities. " 04/01/2008 - "We present a patient who developed vancomycin-resistant enterococcal ventriculitis - meningitis after a brain tumor resection and ventriculoperitoneal shunt placement, treated successfully with intrathecal streptomycin through bilateral cerebrospinal fluid drainage catheters in addition to systemic antibiotics. "

Therapies and Procedures

1.	Catheters 09/01/2014 - "Many studies demonstrate that the accuracy of freehand catheter placement for cerebrospinal fluid drainage is suboptimal. " 10/01/2022 - "VA shunts become an option for cerebrospinal fluid drainage when it becomes unequivocally clear in a multidisciplinary setting that the peritoneal catheter is unlikely to work in view of the unfavourable circumstances of the peritoneal cavity." 01/01/2022 - "Multilevel catheter-guided blood patches have the potential to be administered to higher level spinal regions to the pediatric population suffering from multiple spontaneous cerebrospinal fluid leaks." 01/01/2022 - "There is increasing evidence for the use of multilevel epidural catheter-guided blood patches to treat spontaneous cerebrospinal fluid leaks in adults. " 02/24/2021 - "It can also occur following cerebrospinal fluid leak after skull base surgery and epidural catheter placement. "
2.	Therapeutics 11/01/2023 - "Contributions of the first large scale comparative effectiveness trial have advanced knowledge, especially for the use of hyperosmolar therapies and cerebrospinal fluid drainage in severe paediatric TBI. " 04/01/2023 - "Lumbar puncture (LP) is routinely used for both diagnosis and therapy (via cerebrospinal fluid drainage) of IIH. " 01/01/2022 - "The pre- and post-operative statements mainly focused on indications for dual antiplatelet therapy and its management, considering the possible need for cerebrospinal fluid drainage. " 12/01/2021 - "Patients admitted to the NCCU who had an EVD placed for cerebrospinal fluid drainage and intracranial pressure (ICP) monitoring underwent supine CE therapy with passive and active cycling settings. " 10/01/2021 - "Therapy consists of cerebrospinal fluid drainage through a shunt, which should be performed as early as possible to improve the chances of success. "
3.	Sutures (Suture) 05/01/2022 - "As a result, TSS has also been performed for surgeries with large dural defects, and the deep dural suture method(DDSM)has been advocated mainly in Japan while TSS has been improved to prevent cerebrospinal fluid leakage. " 10/26/2022 - "While a massive dura can be repaired with absorbable suture lines, cerebrospinal fluid leakage can be attenuated by dural sealant when an unintended tiny durotomy occurs intraoperatively. " 03/20/2020 - "Ten patients had primary healing at the edge of the flap suture; 2 patients had local sinus tract formation at the suture site of flap, with a small amount of cerebrospinal fluid leakage, and were recovered after outpatient dressing change. " 02/01/2020 - "In addition, the adequate sealing of the dura may be sufficient to prevent cerebrospinal fluid leakage, without the need for dural suture and lumbar drainage." 01/01/2020 - "Intraoperative dural tear and cerebrospinal fluid leakage occurred in 3 patients and were managed by suture repair and lumbar drain. "
4.	Epidural Blood Patch 01/01/2022 - "Although a definite site of cerebrospinal fluid leakage could not be identified in our case, clinical symptoms and imaging findings were improved after an epidural blood patch. " 08/01/2019 - "The efficacy of fluoroscopy-guided epidural blood patch in the treatment of spontaneous and iatrogenic cerebrospinal fluid leakage." 12/01/2022 - "Cerebrospinal fluid leaks after diagnostic lumbar puncture are often treated using an epidural blood patch; however, there are situations in which this may not be a desirable or safe option. " 10/01/2022 - "Epidural Blood Patch on Cerebrospinal Fluid Leakage Caused by Iatrogenic Dural Injury After Transforaminal Lumbar Interbody Fusion." 07/01/2022 - "A Single-Level Epidural Blood Patch for Multiple Cerebrospinal Fluid Leaks: How it Works."
5.	Conservative Treatment 11/01/2021 - "Results: All 36 patients successfully completed the operation,the operation time was (88.6±24.6) minutes(range:60 to 150 minutes).The intraoperative blood loss was (426.7±167.4) ml(range:250 to 800 ml).Follow-up time was (27.2±7.7) months(range:12 to 48 months).The mJOA score at the last follow-up was 9.0±1.5,which was statistically significant compared with the preoperative score 5.4±1.8 (t=13.59,P<0.01).The improvement rate of mJOA score was (65.7±22.1) %,of which 17 cases were excellent (47.2%),13 cases were good (36.1%),4 cases were normal (11.1%),2 cases were ineffective (5.6%).Ten patients had cerebrospinal fluid leakage during the separation or removal of dural ossification and were cured after a series of comprehensive conservative treatment.Two" 04/01/2006 - "Cerebrospinal fluid leakage occurred in one patient, and was cured with conservative treatment in 2 weeks. " 01/24/2022 - "Conservative Management of Post-Operative Cerebrospinal Fluid Leak following Skull Base Surgery: A Pilot Study." 05/25/2020 - "Cerebrospinal fluid leakage occurred in 3 cases after surgery, which were healed after conservative treatment. " 01/01/2019 - "Transient cerebrospinal fluid leakage occurred in 3 patients during the activation phase but recovered with conservative therapy. "