Spontaneous cerebrospinal fluid leak in a resource-limited setting: diagnostic strategy and surgical outcomes without advanced imaging

Abstract

Spontaneous cerebrospinal fluid (CSF) leaks remain diagnostically challenging, particularly in resource-limited settings where access to Beta-2-transferrin testing and CT cisternography is restricted. The objective was to describe the clinical characteristics, diagnostic approach, and surgical outcomes of spontaneous CSF leaks managed without advanced diagnostic modalities in a tertiary referral centre in Indonesia. A retrospective case series was conducted on six patients diagnosed with spontaneous CSF leak between 2023 and 2025. Diagnosis was established using clinical evaluation, nasal endoscopy, bedside testing, and high-resolution computed tomography (HRCT). Surgical repair was performed using endoscopic techniques. Clinical outcomes and postoperative complications were evaluated. The majority of patients were middle-aged females (83.3%) with elevated body mass index and associated comorbidities. Leak sites were predominantly located at the sphenoid sinus and cribriform plate, with meningoencephaloceles identified in four cases. Despite the absence of β2-transferrin testing and CT cisternography, HRCT combined with clinical assessment successfully localized defects. All patients underwent endoscopic repair with favorable outcomes, minimal complications, and short hospital stays. In resource-constrained settings, a structured diagnostic approach integrating clinical evaluation and HRCT can effectively guide management of spontaneous CSF leaks. Endoscopic repair remains a safe and effective treatment modality even in the absence of advanced diagnostic tools.