Management of Cerebrospinal Fluid Leaks

II. OVERVIEW By definition, PBI violates the subarachnoid space and creates a potential CSF leak. In addition to leakage from entry or exit sites, a fistula may occur at a remote site because of skull fracture and a dural tear from a blowout mechanism. High-velocity missiles may create transients of extremely high intracranial pressure, which can produce fractures even in the base of the skull. The management of leaks at entry and exit sites requires surgical closure of wounds to the skin, fascia, and dura mater. Management of remote CSF leaks depends on recognition of the leak and prompt closure of the fistula either by a direct surgical approach or by CSF diversion when appropriate. The basic reason for addressing CSF leaks is the perceived correlation with infection.