Brief Answer: Emphasize on the risk of infection Detailed Answer: Dear patient, Thanks for your query. The biggest risk of a persistent, unrepaired CSF leak is that of communication between an external contaminated surface with the sterile central nervous system, resulting in infection (eg. meningitis). There is reasonable literature to support this (see citation and abstract below): Neurosurg Focus. 2003 Dec 15;15(6):E6. Spinal pseudomeningoceles and cerebrospinal fluid fistulas. Couture D1, Branch CL Jr. Author information 1Department of Neurosurgery, Wake Forest University School of Medicine, Winston-Salem, North XXXXXXX 27157-1029, USA. Abstract Spinal pseudomeningoceles and cerebrospinal fluid (CSF) fistulas are rare extradural collections of CSF that result following a breach in the dural-arachnoid layer. They may occur due to an incidental durotomy, during intradural surgery, or from trauma or congenital abnormality. The majority are iatrogenic and occur in the posterior lumbar region following surgery. Although they are often asymptomatic, they may cause low-back pain, headaches, and even nerve root entrapment. Leakage of CSF from the wound may cause a fistulous tract, which is a conduit for infection and should be repaired immediately. Diagnosis can be confirmed on clinical examination or imaging studies including magnetic resonance imaging, computerized tomography myelography, and radionuclide myelography. Treatment must be specific to each patient because the timing, size, symptoms, and location of the dural breach all affect the choice of therapy. Nonsurgical methods may be used, but more frequently operative repair is required. In this article, the authors review the diagnosis and treatment of spinal pseudomeningoceles and CSF fistulas. Hope this helps, wish you the best, Dr Brenes-Salazar MD Mayo Clinic MN

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