The presence of a dedicated instruments, the Skull Base Team, the knowledge of reconstructive materials and techniques represents a decisive result in therapeutical management even if for each patient an effective therapeutic algorithm can be obtained considering the correct leak detection and characteristics. However, a clinical multidisciplinary evaluation as well as treatment, is essential to decrease the rate of failure of surgery. An accurate assessment of both predisposing factors and comorbidities is mandatory in case of spontaneous leaks.
The main effort seems to be related to the precise localization of the leak. The diagnosis and treatment of CSF leaks represent a difficult and challenge task. Post-operative complications, long-term sequelae and hospital stay are strongly reduced thanks to endoscopic approach. During the last three decades, surgical treatment has mostly shifted to endonasal endoscopic approach, which widely demonstrated to be more effective than invasive intracranial ones. Diagnosis is both clinical and radiological.
Spontaneous fistulas seem to be mainly related to obesity and idiopathic intracranial hypertension. According to different etiologies, CSF leaks may be classified into two main categories: traumatic and spontaneous. Cerebrospinal fluid (CSF) leak remains a rare condition, characterized by serious complications and potentially fatal.
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