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Management LCS Leakage

A 27-year-old female experienced delayed cerebrospinal fluid (CSF) leakage 4 days after undergoing frontal tumor removal surgery. The tumor occupied the entire frontal bone. Two weeks of conservative management including bed rest, antidiuretics, and antibiotics did not improve the CSF leakage. Lumbar drainage was then performed for 7 days to reduce CSF flow through the frontal bone defect and accelerate healing. This successfully resolved the CSF leakage without the patient developing meningitis. Lumbar drainage can be an effective management approach for delayed CSF leakage after frontal tumor surgery.

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Yovanka Naryai Manuhutu
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190 views1 page

Management LCS Leakage

A 27-year-old female experienced delayed cerebrospinal fluid (CSF) leakage 4 days after undergoing frontal tumor removal surgery. The tumor occupied the entire frontal bone. Two weeks of conservative management including bed rest, antidiuretics, and antibiotics did not improve the CSF leakage. Lumbar drainage was then performed for 7 days to reduce CSF flow through the frontal bone defect and accelerate healing. This successfully resolved the CSF leakage without the patient developing meningitis. Lumbar drainage can be an effective management approach for delayed CSF leakage after frontal tumor surgery.

Uploaded by

Yovanka Naryai Manuhutu
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as DOCX, PDF, TXT or read online on Scribd
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Management of Delayed CSF Leakage After Frontal Based Tumor Removal : A Case

Report

Syaiful Ichwan2, Yovanka N Manuhutu1 Hanif Tobing2, David Tandian2, Renindra A


Aman2, Setyo Widi Nugroho2, Affan Priyambodo2
1Resident of Department of Neurosurgery, Faculty of Medicine, Univeritas
Indonesia
2Department of Neurosurgery, Faculty of Medicine, Universitas Indonesia

Cipto Mangunkusumo General Hospital, Jakarta

Background
Cerebrospinal fluid leakage (CSF) is a complication that sometimes happen unavoidably
in skull base procedures. Many studies have been conducted covering several clinical
aspects such as: risk factors, types of lesions, management, and prevention. CSF
leakage can occur directly or delayed postoperatively. In this case report, it is explained
the management of delayed cases of CSF leakage after tumor removal.

Case Report
Female, 27 y.o, diagnosis of delayed CSF leakage after tumor removal on frontal based.
Intraoperatively, the tumor occupied the whole frontal bone ranging from its curve into the
base, the whole bone was removed with the result was Meningioma WHO gr 1. The first
three days postoperatively, the surgical wound was good and no salty sensation, up to
day 4 the patient complained about the clear liquid coming out of the nose while sleeping
and sitting with a salty sensation. Betadine test positive. Then with bed rest, antidiuretics,
antibiotics, there was no improvement in 2 weeks. It was decided to perform lumbar
drainage.

Discussion
Management of CSF leakage can be done conservatively or operatively. Intraoperatively,
the tumor occupied the whole frontal bone ranging from its curve into the base, the whole
bone was removed. There is a suspicion that CSF leakage can occur. Water tight suturing
of the dura was performed, frontal sinus mucosal coagulation and putting bone wax at the
frontal sinus with fibrin glue. Due to the damage of periosteum and fascia above the tumor
and the sizes of the tumor we cannot find any vascularize tissue than can be used to
cover up the defect. That is why the delayed CSF leakage was occured. Lumbar drainage
followed by bed rest for 7 days to reduce CSF flow in frontal base defects in order to
accelerate the healing process by reducing CSF flow through the defect.

Conclussion
CSF leakage can occur several days after surgery. Meningitis can be avoided by giving
the right antibiotics. Lumbar drainage management in this case is very useful and is
proven to bring maximum results in resolving CSF leakage.

Keywords : Rhinorrhea, CSF Leakage, Lumbar Drainage

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