Management of Cerebrospinal Fluid Leaks After Vestibular Schwannoma Surgery

Objective: To evaluate the incidence and treatment of cerebrospinal fluid (CSF) leaks after resection of vestibular schwannomas and to propose a treatment algorithm for their management. Study Design: Retrospective chart review. Setting: Tertiary referral center. Patients: Review of 1,922 subjects who underwent resection of vestibular schwannomas from 1970 to 2010. Intervention: Surgical resection of vestibular schwannoma. Main Outcome Measures: Patient demographics, surgical approach used, CSF leak incidence, meningitis, treatment, and success in the management of CSF leaks. Results: Postoperative CSF leaks were observed in 12.9% of our patients. There was no significant difference between the type of approach and the presence of CSF leak with translabyrinthine, suboccipital and middle fossa CSF leak rates of 12%, 12%, and 13%, respectively (p = 0.07). Patients presented with a wound leak or rhinorrhea almost equally. Ultimately, 92% of patients with rhinorrhea underwent surgical intervention. The probability of a patient with rhinorrhea requiring a second intervention was higher when the initial intervention was conservative rather than surgical. However, the probability of a patient with a wound leak requiring a second intervention was essentially the same when initially treated conservatively or surgically. Conclusion: Our data suggests that there is no difference in CSF leak rates between the different surgical approaches. The appropriate treatment strategy is dependent on the presentation of the CSF. Although conservative treatment is effective for managing wound leaks, it is less effective in managing patients with rhinorrhea. Therefore, surgical treatments should play an early role in the treatment algorithm of patients with CSF rhinorrhea. Key Words: Acoustic neuroma-Cerebrospinal fluid leak-Vestibular schwannoma.