1. Dr. Amanj Burhan Special neurosurgeon 4/19/20151

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4. CSF leak Traumatic AccidentIatrogenic Non traumatic 4/19/20154

5. Non traumaticHigh pressureTUMORHYDROCEPHALUSNormal pressure OSTEOMYELITIC ERROSION FOCAL ATROPHY CONGENITAL ANOMALIES 4/19/20155

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12. Diagnosis 1-identification of CSF by 1.CSF is clear like water 2.not excoriate the nose 3.salty taste 4/19/201512

13. Biochemical tests : – sugar more than 30 mg/ dl, false positive 60% present, negative test very useful to exclude csf, – beta 2 transferrin – trace protein( more sensitive ) 4/19/201513

14. 2. Site of fistula localization A.Plain X ray : 20% helpful B.CT Scan to rule out hydrocephlaus and neoplasm, non contrast CT for bony abnormality,contrast CT to identify leaking site associated with adjacent abnormal brain paranchyma C.Water soluble contrast CT cisternography ( ws- ctc) used when site of leak not localized by CT, multiple bony defect to identify active leaking site D.MRI : T2 prone position : 4/19/201514

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17. Treatment of traumatic CSF leak 1. duration of conservative management before surgery Most stops spontaneously Indication of surgery in first 2 weeks a)Not decreased rate of leak ( one week) b)Decreased initially and then continue for more than 10 – 12 days c)Meningitis d)Special cases : extensive skull fracture involving frontal air sinuses and during operation of compound skull fracture when dural tear discovered 4/19/201517

18. 2.Antibiotics : Send for C/S Start broad spectrum antibiotics Change antibiotics according to the result of the C/S Repeat C/S every 48 hour for one week 4/19/201518

19. Approaches of surgery : Intracranial Intradural approach ( procedure of choice ) Intracranial Extradural approach Extra cranial Trans nasal approach 4/19/201519

20. Treatment of non traumatic type Treatment of the cause – Tumor : removal – Hydrocephalus : shunt 4/19/201520

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