Dr. Amanj Burhan Special neurosurgeon

1. CSF LEAK Dr. Amanj Burhan Special neurosurgeon

12. Diagnosis 1-identification of CSF by • CSF is clear like water • not excoriate the nose 3.salty taste

13. Biochemical tests : • sugar more than 30 mg/ dl , false positive 60% present , negative test very useful to exclude csf , • beta 2 transferrin • trace protein( more sensitive )

14. 2. Site of fistula localization • Plain X ray : 20% helpful • CT Scan to rule out hydrocephlaus and neoplasm , non contrast CT for bony abnormality ,contrast CT to identify leaking site associated with adjacent abnormal brain paranchyma • Water soluble contrast CT cisternography ( ws-ctc) used when site of leak not localized by CT , multiple bony defect to identify active leaking site • MRI : T2 prone position :

17. Treatment of traumatic CSF leak • 1. duration of conservative management before surgery • Most stops spontaneously • Indication of surgery in first 2 weeks • Not decreased rate of leak ( one week) • Decreased initially and then continue for more than 10 – 12 days • Meningitis • Special cases : extensive skull fracture involving frontal air sinuses and during operation of compound skull fracture when dural tear discovered

18. 2.Antibiotics : • Send for C/S • Start broad spectrum antibiotics • Change antibiotics according to the result of the C/S • Repeat C/S every 48 hour for one week

19. Approaches of surgery : • Intracranial Intradural approach ( procedure of choice ) • Intracranial Extradural approach • Extra cranial Trans nasal approach

20. Treatment of non traumatic type • Treatment of the cause • Tumor : removal • Hydrocephalus : shunt

21. Thank you