Management of Persistent Cerebrospinal Fluid Fistula after Preoperative Lumbar Drain Using Epidural Blood Patch and Fibrin Sealant

Abstract Cerebrospinal fluid (CSF) leaks following neurosurgical procedures can cause significant morbidity and mortality due to the risk of meningitis and require prompt management. Persistent CSF fistulas after temporary lumbar drainage are rare, especially in pediatric patients. A 12-year-old boy underwent temporary preoperative lumbar drainage to facilitate a subtemporal approach for excision of a basal arteriovenous malformation. Postoperatively, a persistent CSF fistula developed at the drain site despite conservative measures and primary suturing. The leak progressed to meningitis, which was treated with antibiotics. Definitive control was achieved using multiple epidural patches with autologous blood and fibrin sealant, resulting in complete resolution. Persistent CSF leakage can occur even after short-term lumbar drainage in children and may lead to serious infectious complications. Early identification and timely escalation to targeted interventions such as epidural blood and fibrin patches can effectively manage refractory leaks and prevent further morbidity.