O'Leary Sean, Gowda Prashanth, Prabhakar Akshay, Jenkins Abigail, Darko Kwadwo, Azam Faraaz, Robledo Ariadna, Luna Aaron E, Bonsrah Nancy A, Still Megan E H, Aoun Salah G, Whittemore Brett A, Barrie Umaru, Braga Bruno P, Totimeh Teddy
Department of Neurosurgery, University of Texas Medical Branch, 301 University Blvd, Galveston, TX, 77555, USA.
Department of Neurosurgery, University of Texas Southwestern Medical Center, Dallas, TX, USA.
Neurosurg Rev. 2024 Dec 30;48(1):14. doi: 10.1007/s10143-024-03162-w.
Cerebrospinal fluid (CSF) leaks commonly occur due to trauma or surgical procedures. Here we review CSF leak diagnosis and management in Low- and Middle-Income Countries (LMICs). A systematic review of the CSF leak management in LMICs was conducted using PubMed, Google Scholar, Embase and Web of Science databases according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Eighteen articles with 3,596 patients (mean age = 39.58 years) were analyzed. Of these patients, 31.37% (1,128/3,596) were reported to have developed cranial CSF leaks. The predominant presentation of CSF leak included symptoms of rhinorrhea, headache, meningitis, and visual impairment. The primary etiology of CSF leak was complications from endoscopic surgery (482 patients), followed by spontaneous origin (46 patients), craniotomy (44 cases), and trauma from motor vehicle accidents (43 cases). Computed tomography (CT) scans (10 retrospective, 15 case, and 1 comparative study) and magnetic resonance imaging (MRI) (6 retrospective, 11 case, and 2 comparative studies) were identified as the most utilized diagnostic modalities. The endoscopic endonasal technique emerged as the predominant surgical approach for managing CSF leak (5 retrospective, 13 case, and 1 comparative study). Moreover, both acellular dermal matrix and turbinate flaps demonstrated comparable repair rates in the management of CSF rhinorrhea (95.23% and 96.00%, respectively). Additionally, porcine-derived fibrin sealant exhibited enhanced success rates for repairs in craniotomies, increasing from 49.21% to 97.81%. This study demonstrates progress in the diagnosis, treatment, and management of cerebrospinal fluid (CSF) leaks within LMICs, including the noteworthy advancement from traditional microscope utilization to the endoscopic endonasal technique.
脑脊液（CSF）漏通常因创伤或外科手术而发生。在此，我们回顾低收入和中等收入国家（LMICs）中脑脊液漏的诊断和管理。根据系统评价和Meta分析的首选报告项目（PRISMA）指南，使用PubMed、谷歌学术、Embase和科学网数据库对LMICs中脑脊液漏的管理进行了系统评价。分析了18篇文章，共3596例患者（平均年龄=39.58岁）。在这些患者中，据报告有31.37%（1128/3596）发生了颅底脑脊液漏。脑脊液漏的主要表现包括鼻漏、头痛、脑膜炎和视力障碍等症状。脑脊液漏的主要病因是内镜手术并发症（482例患者），其次是自发性病因（46例）、开颅手术（44例）和机动车事故创伤（43例）。计算机断层扫描（CT）（10项回顾性研究、15项病例研究和1项比较研究）和磁共振成像（MRI）（6项回顾性研究、11项病例研究和2项比较研究）被确定为最常用的诊断方式。内镜鼻内技术成为治疗脑脊液漏的主要手术方法（5项回顾性研究、13项病例研究和1项比较研究）。此外，脱细胞真皮基质和鼻甲瓣在脑脊液鼻漏的治疗中显示出相当的修复率（分别为95.23%和96.00%）。此外，猪源纤维蛋白密封剂在开颅手术修复中的成功率有所提高，从49.21%提高到97.81%。本研究表明，LMICs在脑脊液（CSF）漏的诊断、治疗和管理方面取得了进展，包括从传统显微镜的使用到内镜鼻内技术的显著进步。
