A Study of CSF Leak after Cranial Surgery: A Prospective Study

Introduction: Cerebrospinal fluid (CSF) leaks are well-known and frequent complications of intracranial procedures. The duramater closure is important to prevent CSF leak, subgaleal collection and future infection. Dural closure done by approximation of the dural edges with suture i. e. primary closure of dura or by inserting a graft material between the dural defect i. e. K/a duraplasty. Watertight dural closure is often not possible. Therefore, numerous techniques and materials developed to obtain the �perfect� closure, which should result in the reduction of CSF. It is important to study the incidence, risk factors, treatment, complications and various method of closure of dura as CSF leakage leads to increased morbidity, prolongation of hospital stay, surgical revision, and enhanced cost of treatment. Aim and objective: To Study incidence, risk factors, treatment and complications of CSF leak after Cranial Surgery. Methods: Total 332 patients who underwent craniotomy for various indications at Hamidia Hospital, Bhopal for one and half year. On admission patient�s history, neurological examination, indication of craniotomy& relevant investigations, incision and method of dural closure were recorded. Each patient was clinically assessed for 2 weeks post-op period for any CSF collection, leak& other complications. Results: Incidence of post op CSF leak is 11.14 % ( 37 patients). Risk factor for CSF leak are middle age group, female, diabetes, long duration of procedure, steroid for longer duration, infratentorial pathology and craniotomy done for tumor pathology. Maximum CSF leak incidence reported in which dural closure was not done and loose approximation than use of various graft, but minimum incidence with water tight dural closure. No significant difference in various treatment methods reported in Compressive dressing, Re-suturing of the wound, lumber drain, and v-p shunt. Common Complication of CSF leak is surgical site infection, meningitis, pseudomeningocele, and Epidural empyema, CSF hygroma etc. Conclusion: water tight dural closure or graft or sealant should be used to decreases CSF leak incidence. Initially conservative method like compressive dressing and resuturing of wound with higher antibiotic and later stage lumber tapping/drain or v-p shunt should be used.