Although some mechanisms account for the CSF leakage have been elucidated, spinal canal stenosis has never been reported as a pathological cause of intracranial hypotension. There appears to be a low risk of meningitis among patients with lateral skull base sCSF leaks awaiting surgery for short durations (≤2 months), even in the absence of prophylactic antibiotics. Background Intracranial hypotension is a disorder characterized by low cerebrospinal fluid (CSF) pressure typically caused by loss of CSF. No studies in the published literature demonstrated the impact of prophylactic antibiotics or pneumococcal vaccine on meningitis risk. 1 It frequently occurs as a result of trauma to the anterior skull baseaccidental (nearly 80) or iatrogenic (1015). Cerebrospinal fluid (CSF) leak can be spontaneous or nonspontaneous. The spectrum of clinical and radiographic manifestations is varied, with diagnosis largely based on clinical suspicion, cranial magnetic resonance imaging, and myelography. Eighty-eight percent of patients did not receive prophylactic antibiotics. Cerebrospinal fluid (CSF) rhinorrhea is the leakage of CSF through nasal cavity due to abnormal communication between the arachnoid membrane and nasal mucosa. Spontaneous spinal cerebrospinal fluid leaks and intracranial hypotension Spontaneous intracranial hypotension is not rare but it remains underdiagnosed. Institutional review identified 87 patients who underwent surgical repair of spontaneous leaks, with a 0% incidence of meningitis over a median duration of 2 months while awaiting surgery (mean 5.5 months, range 0.5-118 months). Practically all cases of spontaneous intracranial hypotension results from spontaneous cerebral spinal fluid (CSF) leaks, often at the level of the spine and only rarely from the skull base. Doctors call this a spontaneous CSF leak. Data was collected on receipt of prophylactic antibiotics and/or pneumococcal vaccines during the timeframe between diagnosis and surgical repair. In some cases, there’s no known cause for a leak.
Adults managed surgically for sCSF leaks at an academic tertiary care center over a 10-year period were included. To review the literature and our institutional experience regarding the risk of meningitis in patients with spontaneous lateral skull base cerebrospinal fluid (sCSF) leaks awaiting surgical repair, and the roles of antibiotic prophylaxis and pneumococcal vaccination, if known.Ī retrospective chart review and systematic review of the literature was undertaken to identify the incidence of meningitis in patients with sCSF leaks awaiting surgical repair.
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