Clinical confirmation is made by laboratory analysis of the nasal fluid for β 2-transferrin or beta trace protein. Spontaneous CSF rhinorrhea has no identifiable etiology and typically presents unilaterally in obese, middle-aged women. Non-iatrogenic traumatic CSF leaks however are likely to resolve spontaneously, making non-surgical management within the first days acceptable. A recent systematic review found iatrogenic injuries unlikely to heal spontaneously, requiring initial surgical repair. Traumatic CSF leaks often settle with conservative treatment, but the risk of ascending meningitis must be taken into consideration. An endoscopic endonasal approach is now considered the golden standard with overall success rates averaging around 90%, increasing to 96.6% when including second attempts at repair. Treatment strategies differ according to the underlying etiology and leak location but surgical repair is often needed. ![]() The latter reported spontaneous fistulae to be the most commonly reported type, accounting for 41.1% of fistulae. who found an almost identical distribution amongst traumatic (50.2%) vs. found traumatic causes to be more common (61%), as opposed to Psaltis, et al. Congenital and tumor-based leaks are beyond the range of this review, and will therefore not be discussed. ![]() Differentiation is often made between traumatic (either iatrogenic or non-iatrogenic) and non-traumatic (spontaneous, congenital and tumor-based) causes. Future studies, preferably large multicenter randomized controlled trials (RCTs), are warranted to confirm this clinical observation.Īcetazolamide, Cerebrospinal fluid leak, Endonasal endoscopic closure, Idiopathic intracranial hypertensionĬerebrospinal fluid (CSF) rhinorrhea results from communication between the subarachnoid space and sinonasal cavity. Regular administration in the postoperative care of spontaneous CSF leak closures might be considered to increase success rates. She experienced no signs nor symptoms of elevated ICP.Īcetazolamide is widely accepted as first line treatment in IIH and is sometimes used postoperatively after endoscopic closure of spontaneous CSF leaks associated with elevated ICP. Our third patient had an empty sella on preoperative imaging, a finding often associated with IIH, and therefore was given acetazolamide immediately postoperative. Still, acetazolamide was administered after which their symptoms subsided. However, further examination was within normal ranges. Postoperatively, two patients experienced headaches resembling those accompanying elevated ICP. We retrospectively reviewed the charts of three patients at our center who were surgically treated for spontaneous CSF leaks. We aim to give an update about the current use of acetazolamide in the postoperative care of spontaneous CSF leak closure. There is growing evidence that active intracranial pressure (ICP) management in the postoperative care can improve success rates. Spontaneous CSF leak closure often requires surgery, which has proven to be less successful than their non-spontaneous counterparts. This is thought to be a variant of idiopathic intracranial hypertension (IIH). Although epidural anesthetic is injected just outside the membrane that surrounds the spinal cord, a spinal headache is possible if the membrane is unintentionally punctured.Spontaneous cerebrospinal fluid (CSF) leaks are defined as leaks without identifiable etiology, often presenting as spontaneous rhinorrhea. Sometimes epidural anesthesia may lead to a spinal headache as well. Spinal headaches typically appear within 48 to 72 hours after a spinal tap or spinal anesthesia. This leakage decreases the pressure exerted by the spinal fluid on the brain and spinal cord, which leads to a headache. Spinal headaches are caused by leakage of spinal fluid through a puncture hole in the membrane (dura mater) that surrounds the spinal cord. ![]() Tell your health care provider if you develop a headache after a spinal tap or spinal anesthesia - especially if the headache gets worse when you sit up or stand. Spinal headaches are often accompanied by:
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