Variants of surgical interventions in craniobasal lesions complicated with long-term CSF leakage

Introduction: The aim of this study was to compare results of surgical treatment of long-term CSF leakage depending on the type of intervention. Methods: For the period from 1988 to 1995 we operated 90 patients aged 3-70 (average 28.5 ± 1.4 years). Of them: 8 (8.9%) were operated in the acute stage of CCT, 12 patients (13.3%) - in the intermediate stage and 70 (77.8%) - in the delayed period. Duration of the CSF fistulae before surgery made up 1 month - 25 years (average 3.8 ± 0.5 years). Results: Before 1990 intracranial intervention was combined with recurrent lumbar punctures following surgery (29 cases); CSF leakage recurred in 5 observations (17.3%). Later on (48 cases) methods of intra-and postoperative external drainage of the lumbar CSF (up to 17 days; average - 8.5 days) were used. In the first 14 cases (from 1990 to 1992) we performed simple, percutaneous drainage installation. However, high frequency (28.6%) of meningitis in this series proved the necessity of working out a “long-tunnel” method of the CSF drainage. The main point of this method is to lead the catheter from the lumbar region in subcutaneous fat into anterior-lateral surface of the abdominal wall and to connect it with sterile CSF collector. We used this method in 34 patients and only 3 (8.7%) showed meningitis. CSF leakage recurrence was noted in 2 cases (4.2%). In 3 cases intracranial intervention was carried out together with the shunting operation; CSF leakage recurrence was not noted. Shunting operation alone was performed in 10 patients (in 9 cases-lumboperitoneostomy and 1 case-ventriculoperitoneostomy). CSF leakage recurrence was observed in 1 case (10%). Conclusion: Best results of surgical treatment of long-term basal CSF leakage were achieved when we used intracranial intervention together with the method of intra-and postoperative CSF drainage.