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Cerebrospinal Fluid Fistula for the Craniofacial Surgeon

A Review and Management Paradigm

Golinko, Michael S., MD, MA*; Harter, David H., MD; Rickert, Scott, MD; Staffenberg, David A., MD, DSc (Honoris Causa)§

doi: 10.1097/SCS.0000000000003148
Original Article: PDF Only

Craniofacial surgeons perform operations that involve exposure of the dura. Typical procedures include cranial vault remodeling (CVR), fronto-orbital advancement (FOA), Le Fort III, monobloc, bipartition advancement, or distraction. Cerebrospinal fluid (CSF) fistulas remain one of the most common complications encountered, occurring in up to 30% of patients. Cerebrospinal fluid fistulas can be encountered intraoperatively, acutely, or in the late postoperative period. Traditional management has been well described in the neurosurgical literature. While several studies of complications exist, there is a relative lack of adequate information for craniofacial surgeons. The authors review current literature and provide 3 patients to illustrate our management paradigm.

The authors review 30 years of experience at our institution and the pertinent literature. The mean rate of CSF fistula was 11.2%; rates were lowest for FOA/CVR, 5.5%. Patients with fistulas persisting after 2 days of conservative therapy or whom were symptomatic prompted placement of a lumbar subarachnoid catheter. Failure of the leak to resolve with CSF diversion prompted exploration and therapy which could include a patch, pericranial flap, and/or endonasal repair with septal flaps. Three patients are used to illustrate the paradigm, all of which have had no recurrence thus far.

Cerebrospinal fluid fistula remains one of most common complications craniofacial surgeons encounter. Although neurosurgeons are often part of the clinical team, the craniofacial surgeon should be familiar with all aspects of treatment. Prompt diagnosis and appropriate knowledgeable management may avoid morbidity and mortality.

*Division of Plastic Surgery, Arkansas Children's Hospital, University of Arkansas Medical Sciences

Department of Neurosurgery, New York University Langone Medical Center

Department of Otolaryngology, New York University Langone Medical Center

§Hansjörg Wyss Department of Plastic Surgery, New York University Langone Medical Center, New York, NY.

Address correspondence and reprint requests to David A. Staffenberg, MD, DSc(Honoris Causa), Hansjörg Wyss Department of Plastic Surgery, New York University Langone Medical Center, 305 East 33rd Street, New York, NY 10016; E-mail:

Received 4 October, 2015

Accepted 14 August, 2016

An abstract form of this manuscript was accepted for podium presentation at the International Society of Craniofacial Surgeons Biennial meeting in Japan, September 2015.

The authors report no conflicts of interest.

© 2019 by Mutaz B. Habal, MD.