Incidence and Management Outcomes of Cerebrospinal Fluid Leaks Following Craniofacial Cleft Repair: A Retrospective Cohort Study

Abstract

Objective

To determine the incidence of cerebrospinal fluid (CSF) leaks after craniofacial cleft repair and to describe outcomes of conservative and surgical management approaches.

Design

Retrospective cohort study.

Setting

Fatemeh Hospital, a tertiary referral center for craniofacial and neurosurgical procedures in Tehran, Iran.

Patients, Participants

A total of 121 patients who underwent primary or secondary craniofacial cleft repair between June 2019 and March 2024. Patients with a history of craniovertebral junction surgery, Chiari malformation, or ventriculoperitoneal shunting were excluded.

Interventions

Patients with postoperative CSF leaks were managed with either lumbar drainage or surgical re-exploration. Intraoperative autologous fat grafts were used prophylactically in select patients without visible dural defects.

Main Outcome Measure(s)

Incidence of postoperative CSF leaks, occurrence of meningitis in leak cases, and resolution of leaks following conservative versus surgical treatment.

Results

CSF leaks occurred in 18 patients (14.8%), of whom 9 (50%) developed meningitis. Leak rates by Tessier classification were class 0 (19.6%), class 1 (12.1%), class 2 (11.1%), and class 3 (0%). There was no statistically significant association between cleft type and CSF leak incidence (P = .478). Lumbar drainage resolved CSF leakage in 7 patients (38.9%), while 15 patients (83.3%) ultimately required surgical re-exploration. One leak (9%) occurred among the 11 patients who received prophylactic fat grafts.

Conclusions

CSF leaks were observed in approximately 15% of craniofacial cleft repairs and were frequently associated with meningitis. Surgical intervention was often required, highlighting the need for careful intraoperative dural management and early leak detection.