What is the best method to treat CSF leaks following resection of an acoustic neuroma?

BACKGROUND While the published rates of cerebrospinal fluid (CSF) leak following acoustic neuroma resection varies, it remains a known complication. It is unclear if tumor size and surgical approach affect the risk of CSF leak postoperatively. Meticulous surgical technique during middle fossa, retrosigmoid, and translabyrinthine approaches, along with judicious use of perioperative lumbar drains, have decreased the leak rate over the previous decades. Despite these improvements, CSF leaks postresection presents a management challenge. The best method to deal with this problem remains to be proven. Optimal management would be minimally invasive, carry little morbidity, prevent unnecessary surgical procedures, and not prolong treatment with ineffective interventions. Those patients that require more invasive treatment should be identified early to prevent delay of optimal management.