Comparative study between primary spontaneous cerebrospinal fluid fistula and late traumatic fistula.

OBJECTIVE

To compare primary spontaneous cerebrospinal fluid fistula (PSF) and late traumatic fistula (LTF).

STUDY DESIGN

Historical cohort study.

SETTING

Academic medical center.

SUBJECTS AND METHODS

There were 26 patients with PSF in group 1 and 23 patients with LTF in group 2. Gender, age, location of the osteomeningeal breach, time between symptom onset and surgical treatment, number of episodes of meningitis, and density of the incidence of meningitis were compared. Two factors related to chance of curing the fistula were analyzed: etiological type and fistula location.

RESULTS

In group 1, 92% of patients were women (mean age 50 years). In group 2, 74% were men (mean age 22 years). PSF predominated in the sphenoid sinus (60%), whereas LTF occurred mainly in the ethmoidal (33%) and frontal (28%) sinuses. Time between presentation and surgical treatment was 28.9 ± 50.2 and 12.4 ± 15.5 months in groups 1 and 2, respectively (P = .166). There were 0.6 and 1.3 episodes of meningitis per patient in groups 1 and 2, respectively (P = .038). Density of the incidence of meningitis was 0.1 and 0.2 events per patient-month, respectively (P = .016). The 4 not-cured patients had sphenoid lesions and were from the PSF group.

CONCLUSIONS

Female sex, middle age, and sphenoidal fistula were prevalent in patients with PSF. Patients with LTF were twice as likely to develop meningitis, and male sex, young age, and leaks through the frontal and ethmoidal region were more common in this case. Osteomeningeal breach located in the sphenoid sinus had a lower chance of sealing.