Although a small leak of cerebrospinal fluid (CSF) is seen at operations, it can usually be managed without any problems, even for those of us who do not formally repair the fossa floor. Combinations of repair material or even judicious bipolar coagulation of the dura as practiced by de Tribolet (personal communication) are usually sufficient to contain the leak (see also Chapter 8). Persistent postoperative rhinorrhea, on the other hand, demands reoperation and repair.
The authors have abandoned temporary lumbar drainage, even though it has worked occasionally in the past. The complications of air encephalopathy and late meningitis, which we have all seen, means that we repair all late leaks at formal reoperation as soon as possible.
There is no evidence to support the use of prophylactic antibiotics when a CSF leak is diagnosed, but any symptoms or signs of meningitis require prompt lumbar puncture with CSF microscopy and appropriate antibiotic therapy.
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