CSF Leak Repair — sealing the breach at the skull base.

Overview

CSF can leak into the nose through a small defect in the thin bone of the skull base — most often after trauma, after sinus or skull-base surgery, or spontaneously (typically in patients with raised intracranial pressure).

Endoscopic repair has replaced open neurosurgical approaches for almost all of these cases. A graft of fat, fascia, or mucosa is layered over the defect, and recovery is much shorter than after open surgery.

When This Surgery Is Recommended

• Clear watery nasal discharge confirmed as CSF on beta-2 transferrin testing
• Post-traumatic CSF leak not settling on conservative management
• Spontaneous CSF leak associated with raised intracranial pressure
• CSF leak complicating sinus or skull-base surgery
• Recurrent meningitis with a suspected occult leak

The Procedure

A precise endoscopic operation under general anaesthesia. CT and sometimes MR cisternography are used pre-operatively to locate the defect.

• The exact site of the leak is identified endoscopically
• Mucosa around the defect is gently raised away
• A graft (fat, fascia, or mucosa) is positioned across the defect
• A second supporting layer is often added for security
• Tissue glue or absorbable packing supports the graft until it incorporates

Pre-Surgery Preparations

• Full work-up — CT cisternography or MRI, ICP measurement when relevant
• Prophylactic antibiotics started 24 hours pre-op per protocol
• Fast 8 hours before surgery
• Stop all blood thinners 7 days before
• Counselling on the planned lumbar drain (if applicable) and bed-rest protocol
• Family presence advised for psychological support post-op

Post-Surgery Recovery

• 5–7 days in hospital for monitoring
• Strict bed-rest with head-up positioning for 48 hours
• Avoid coughing, straining, nose blowing for several weeks
• A lumbar drain is occasionally used for short-term CSF diversion
• Office work in 3–4 weeks; full activity in 6 weeks

Follow-up Schedule

• Days 1–7 (in hospital) — bed-rest, drain management, careful monitoring
• Day 10–14 — discharge review and bed-rest taper
• Week 4 — nasal endoscopy and graft check
• Week 12 — confirmation of graft integration; ICP reassessed
• 6 and 12 months — long-term leak surveillance

Potential Complications

• Initial repair success rate 90–95%; revision occasionally needed
• Meningitis risk if leak recurs unrecognised — careful monitoring is essential
• Pressure-related leaks may need long-term medication or shunting
• Bleeding or sinus complications, all uncommon

Why Have It Here

CSF leak repair is unforgiving — the difference between brain coverings and a sinus is millimetres. We work it up properly first (location, cause, intracranial pressure) before reaching for the operation, because the right plan matters more than a quick one.