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Papers of the Week

2022 Dec




Cerebrospinal Fluid Cutaneous Fistula Following Neuraxial Anesthesia for Cesarean Delivery.


Sanha M, Vaz I, Barbosa H, Alves S, Paiva M
Cureus. 2022 Dec; 14(12):e32895.
PMID: 36699750.


Cerebrospinal fluid (CSF) cutaneous fistula is an unusual but potentially serious complication of neuraxial procedures. While combined spinal-epidural (CSE) technique or spinal/epidural techniques alone are standard in obstetric anesthesia, subsequent persistent CSF leak is rarely reported in the obstetric population. Clinical presentation ranges from asymptomatic states and only abnormal leakage through the puncture site to severe cases with meningitis or subdural hematoma. Both conservative and invasive approaches are suitable for management, but no formal guidelines on how to diagnose and manage this condition are available, and hence clinicians have to rely on their experience. We present a case of a 35-year-old parturient scheduled for an elective cesarean delivery with a persistent CSF leak three days after epidural catheter removal. The leakage was managed with both suturing of the skin site and conservative methods such as hydration, bed rest, and oral analgesics, with no adverse effects for the patient.