Thus, we conducted this retrospective study to assess the onset duration, clinical symptoms, management, lengths of hospitalization, and relapse of spontaneous and nonspontaneous CSF leak, and analyzed the data between the two to provide a better treatment strategy. In addition, there was no literature comparing the different causes of CSF leak. Data associated with the management or incidence of relapse were lacking. Most literature focused on the incidence and prevention of CSF leak during the procedure. Procedure-related CSF leak includes lumbar puncture transsphenoidal surgery vestibular schwannoma surgery and cervical, thoracic, and lumbar spine surgeries. Spontaneous CSF leak is commonly found in the sphenoid or in the spine. Headache attributed to low CSF pressure, also known as low-pressure headache, is caused by CSF leak or reduced CSF production. Clinical symptoms include neck pain, tinnitus, changes in hearing, photophobia, and/or nausea. However, the recurrence rates were similar.Ĭerebrospinal fluid (CSF) leak can be spontaneous (primary) or nonspontaneous (secondary). The symptom onset durations and treatment strategies were different. The demographic data and symptoms were similar in various groups of CSF leak. Among the trauma-related CSF leaks, 90.9% of them required surgical repair. Among the spontaneous spine and lumbar puncture-related CSF leaks, 57.1% of them responded to 4 days of conservative treatment. Longer intervals between surgery and CSF leak encouraged reoperation. Earlier reoperation was correlated with shorter hospitalization (r = 0.651), but the recurrence rates were similar. Meningitis occurred in 1/3 of sphenoid, skull base, and calvarian surgeries. MRI pachymeninge enhancement showed the highest sensitivity (78.6%) for intracranial hypotension. The spontaneous group had higher CSF accumulations on their MRIs. Age, gender, body mass index, initial symptoms, hospitalization, treatment courses, and recurrence rates showed no difference between the groups. Spontaneous CSF leak came from the sphenoid or spine. Surgery sites comprised sphenoid, spine, skull base, and calvaria. Nonspontaneous causes included lumbar puncture, surgery, and trauma. Eighty-one patients were recruited: 20 with spontaneous and 61 with nonspontaneous CSF leaks. We compared clinical symptoms, image findings, management options, hospitalization, and relapse rates among different causes of CSF leaks. The management options include conservative treatments, blood patch, and surgical repairs. Cerebrospinal fluid (CSF) leak can be spontaneous or nonspontaneous.
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