Cerebrospinal Fluid Fistula: Clinical Aspects, Techniques of Localization, and Methods of Closure

Abstract

T HE management of cerebrospinal fluid fistula continues to be troublesome despite the apparent simplicity of the problem; as Dandy noted in 1944, disclosure of the fistulous tract may be exceedingly difficult, perhaps even impossible. TM In many instances, preoperative evaluation identifies the site of the fistula, but often the patient undergoes craniotomy without the defect having been precisely localized. Even during operative exploration the site of the fistula may not be disclosed, yet measures must be taken to stop the leak. This report, based on the experience at The New York Hospital-Cornell Medical Center, emphasizes the problems of localizing and closing the fistulas and describes an operative technique helpful in localizing leaks when the preoperative search has failed.