Management Strategies for High-Flow Cerebrospinal Fluid Leaks: A Systematic Review.

BACKGROUND: High-flow CSF leaks pose a great danger to patients and may even cause death. They are caused by cranial trauma, surgical interventions, and spontaneously formed defects in dura mater. Despite extensive scientific research on this subject, there is no consensus regarding treatment strategies. OBJECTIVE: To determine the effectiveness of various approaches to CSF leak reconstruction to minimize the frequency of relapses and complications associated with high-flow CSF leaks, occurring mostly due to skull base surgeries. METHODS: A systematic search in PubMed, Cochrane Library, Scopus, and Embase was conducted. Randomized and nonrandomized controlled trials (cohort studies and case series), including multilayer technique, hydroxyapatite material use, dural suturing, and lumbar drainage as additional procedures, were taken into account as the inclusion criteria. Recurrence and postoperative complications were considered to be the main outcomes of this review. RESULTS: In summary, the probability of successful repair of CSF leaks using the total endoscopic method was 94.2% (95% CI: 91.5%-96.1%), with the incidence of relapse being equal to 5.1% (95% CI: 3.2%-7.9%). The frequency of postoperative meningitis and pneumocephalus was 2.6% and 1.4%, respectively. Among subgroups, similar efficiency was observed, while relapses occurred less often during spontaneous leaks. CONCLUSION: The findings showed that more complicated reconstructions utilizing hydroxyapatite along with dural sutures significantly reduced the likelihood of complications such as CSF leakage.