2026 Poster Presentations
P240: MANAGEMENT OF CEREBROSPINAL FLUID LEAKS AFTER BASILAR SKULL FRACTURES
Alexa R Lauinger1; Wael Hassaneen, MD, PhD2; 1Carle Illinois College of Medicine; 2Carle Neuroscience Institute
Background: Cerebrospinal fluid (CSF) leaks are an uncommon but consequential effect of skull base fractures. They increase the risk for meningitis, hematomas, and herniations; however, most of them can be managed conservatively. Although, early identification and treatment is essential to prevent detrimental complications, especially in cases that require surgical repair. Few studies have explored the factors associated with the development of traumatic CSF leaks and required surgical repair. This project used data from a national database to investigate the variables that contribute to these outcomes.
Methods: The national trauma data bank (NTDB) was queried from 2019 to 2023 for patients with traumatic fractures of the skull base. ICD10 codes were used to identify concurrent diagnoses and procedures for each patient. Additionally, patient demographics and injury details were extracted from the database. Linear regression models were used to identify variables with significant association with a diagnosis of CSF leak after skull base fractures, and those associated with the need for surgical repair.
Results: Our data query resulted in 190,657 patients with a skull base fracture between 2019 and 2023. Of these, 6,948 (3.6%) had a traumatic CSF leak as well. 25.7% of the patients were female overall, and male sex was associated with increased rate of CSF leaks (OR 0.829; 95%CI 0.782-0.877). The average age of the participants was 41.7 +/- 21.9 years old, and a younger age was significantly correlated with CSF leaks (p-value <0.001). Additional factors associated with increased risk of CSF leak were injury by motor vehicle collision (1.215 1.156-1.276), lower Glasgow coma scale score (p-value <0.001), and higher injury severity score (p-value <0.001). While anticoagulant use (0.700 0.613-0.795) and diagnosis of hypertension (0.799 0.748-0.852) or diabetes mellitus (0.837 0.758-0.921) were associated with a lower rate of CSF leak. The multivariable linear regression model included sex, age, ISS, and GCS.
Out of the 6,948 patients with a CSF leak, 282 (4.1%) had a surgical repair with 94.7% being by endoscopic approach. 925 (13.3%) patients had a ventricle drain placed. Younger males were more likely to have a surgical repair done. An increased ISS was associated with an increased rate of surgical repair (p-value =0.002) while GCS was not significantly correlated with it. Even accounting for ISS and GCS, surgical repair was associated with increased length of stay in the hospital (p-value <0.001) and thrombosis (1.791 1.016-2.945) during their stay. Surgical repair did not correlate with differences in surgical site infection rates.
Conclusions: Although CSF leaks occur in around 1-3% of traumatic brain injuries, the variables associated with them are poorly defined. This project found that age and sex may contribute to both the risk for CSF leaks and can help identify those that require surgical repair. Future studies should further investigate how these patient demographics influence outcomes and treatment of traumatic CSF leaks.