Postoperative management after cerebrospinal fluid leak repair in patients with idiopathic intracranial hypertension

Spontaneous cerebrospinal fluid leaks most commonly present in obese middle-aged women. There is consensus that the optimal approach to these skull base defects is via endoscopic skull base repair. However, there is much discussion around optimal postoperative management of these patients given the association with idiopathic intracranial hypertension. Success rates of endoscopic repair are greater than 90% in most studies, with few complications. Skull base repair requires consideration of the skull base defect, repair options, and patient comorbidities that increase the risk of failure of repair. Postoperative management can include perioperative lumbar drains, ventriculoperitoneal shunts, carbonic anhydrase inhibitors, weight loss counseling, and close follow-up to monitor for complications.