Treatment

Observation for 48hours to 72 hours with the head of the 15° to 30° bed elevation. Bed elevation reduces the CSF pressure at the basal cisterns. The patient must avoid coughing, sneezing, nose blowing, abdominal straining and heavy weights lifting for as increased Intra abdominal pressure tends to increase Intra Cranial Pressure.

In case of persistent CSF leakage, a neurosurgical intervention is recommended.

Lumber CSF drain 10 to 15 mL per hour with a total drainage volume of between 150 to 250 mL to help reduction of Intra Cranial Pressure.

Acetazolamide 500 mg twice daily for the first week, followed by 250 mg twice daily for a second week.

A lumbar epidural blood patch involves injecting a small amount of the patient’s own blood into the area around the spinal cord which help sealing the leak.

The endoscopic nasal packing procedure, placement of small, absorbent material into the nasal passages to block the leak and prevent further loss of CSF fluid.

External Ventricular Drainage through anterior fossa craniotomy.

External approaches to the skull base can also be obtained through various incisions or through nasal approaches for access to the ethmoid sinuses and sphenoid sinus. These include external ethmoidectomy, trans ethmoidal sphenoidotomy, trans septal sphenoidotomy, and the trans antral approach to the skull base.