Cerebrospinal fluid leak treatment with surgical leak repair

When conservative treatment is unsuccessful and liquorrhea lasts for more than seven days, the patient needs the help of neurosurgeons to seal the CSF leak. The surgery technique is selected individually, considering the severity of the illness. CSF surgery eliminates trauma or defect of the skull and the dura mater, removes a cavity with cerebrospinal fluid from the brain or spinal cord, and restores the cranial cavity's tightness using adhesive compositions. Different materials and techniques are used depending on the surgical technique when repairing defects in the bones at the base of the skull. These include tissues like the periosteum, wide fascia from the thigh, adipose tissue, cartilage from the nasal septum, and adhesive compositions like Tissucol and Tachocomb. There are three methods to perform the surgery: trepanation of the frontal area (transcranial surgery), bypass surgery, or endoscopic technique through the nasal cavity. The surgery must be conducted in a clinic, typically requiring a hospital stay of 10-14 days. Usually, patients only need one procedure. However, suppose the lateral wall of the sphenoid sinus is harmed. In that case, additional interventions may be necessary due to the challenge of identifying defects during surgery.