How to Prevent Postoperative Cerebrospinal Fluid Leakage(<SPECIAL ISSUE>Complication Avoidance: Anatomical Practice as Operative Training (2))

Abstract

In skull base surgery, knowledge of the techniques used to avoid postoperative cerebrospinal fluid (CSF) leakage is important. CSF leakage can lead to critical infection problems such as meningitis and extradural abscess. It is important to avoid CSF leakage into the subcutaneous surgical cavity and other areas, e.g. rhinorrhea. If subcutaneous fluid collects in spaces, including drilled air cells, then the risk of infection increases. Risks of CSF leakage are classified as dural level and extradural level. Different approaches to the skull base also have different risk levels. We emphasize four techniques for avoiding postoperative CSF leakage: watertight dural closure, filling of dead spaces, external compression, and lumbar drainage. For some surgical approaches, not all of these techniques can be used. In these cases, it is necessary to ensure that the appropriate technique is effectively applied. Skull base surgery is becoming a standard neurosurgical technique. The surgeon who is permitted to open the skull base must be able to close it and reconstruct it reliably. The skull base surgeon must have a knowledge and mastery of the techniques of skull base reconstruction, and must always be aware of the need to prevent CSF leakage.