NOSE AND PARANASAL SINUSES: Edited by Samuel S. Becker and Nithin D. AdappaTreatment of cerebrospinal fluid rhinorrheaDeConde, Adam S.a; Suh, Jeffrey D.b; Ramakrishnan, Vijay R.cAuthor Information aDepartment of Surgery, Division of Otolaryngology – Head & Neck Surgery, University of California San Diego, San Diego bDepartment of Otolaryngology – Head and Neck Surgery, University of California Los Angeles, Los Angeles, California cDepartment of Otolaryngology – Head and Neck Surgery, University of Colorado, Aurora, Colorado, USA Correspondence to Vijay R. Ramakrishnan, MD, University of Colorado, Department of Otolaryngology, 12631 E 17th Ave, B205, Aurora, CO 80045, USA. Tel: +1 303 724 1950; fax: +1 303 724 1961; e-mail: Vijay.Ramakrishnan@ucdenver.edu Current Opinion in Otolaryngology & Head and Neck Surgery: February 2015 - Volume 23 - Issue 1 - p 59-64 doi: 10.1097/MOO.0000000000000124 Buy Metrics Abstract Purpose of review Cerebrospinal fluid (CSF) rhinorrhea is a rare entity that can arise from a variety of causes. Successful management has been reported using a variety of repair techniques. The goal of this study is to make recommendations on intraoperative and postoperative management of CSF fistulas across all causes. Recent findings Pooled analysis of case series reveals that free graft repairs are successful in closing most traumatic and iatrogenic CSF leaks. In contrast, multilayered, vascularized repairs are often required for large defects with high-flow leaks that communicate with a cistern and/or ventricles. Spontaneous CSF leaks are associated with idiopathic intracranial hypertension in the vast majority of cases, and when present, postoperative medical management is necessary for long-term success. Summary Patients with CSF rhinorrhea require surgical repair to prevent life-threatening complications. Many techniques and materials are effective at achieving closure of CSF fistula across causes. Evidence suggests that patients with high-flow CSF fistulas have improved outcomes with multilayered, vascularized repairs to decrease the risk of postoperative CSF leaks. Patients with idiopathic intracranial hypertension need long-term management of the underlying disease process. Copyright © 2015 Wolters Kluwer Health, Inc. All rights reserved.