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2026 SOAP Annual Meeting
April 29 - May 3, 2026 | Montreal, Quebec Canada
2340398
Cerebrospinal Fluid Cutaneous Fistula Following Uncomplicated Neuraxial for Labor Analgesia: A Case Report
Poster Presenter
Part of Topic
CHIARI and OTHER NEURAXIAL CHALLENGES
Cerebrospinal Fluid Cutaneous Fistula Following Uncomplicated Neuraxial for Labor Analgesia: A Case Report
Usman Hyder MD, M Waseem Athar MD, Stanley McSpadden MD, Daniel Bingham MD
Background:
´CSF-cutaneous fistula is an exceedingly rare complication from neuraxial anesthesia. It occurs as a result of communication between the subarachnoid space and skin, at the neuraxial puncture site.
´Most CSF leaks are self resolving; rarely they form tracts leading to CSF-cutaneous fistulae
´Mechanism:
´spinal or epidural needle placement into subarachnoid space
´combined spinal-epidural (CSE) technique
´catheter removal (epidural or intrathecal)
´Clinical presentation: Clear fluid leakage from puncture site
´May be:
´Asymptomatic
´Associated with intracranial hypotension: postural headache, nausea, photophobia – similar to PDPH
´Severe complications: meningitis, subdural hematoma
´
Case:
´25-year-old patient, G2P1, with a history of a prior uncomplicated epidural catheter placement, was admitted at 40 weeks and 2 days for labor induction.
´She underwent a routine epidural catheter insertion, which was uncomplicated, was placed by a single provider, and no dural puncture was noted at time of placement.
´The patient reported adequate analgesia from the epidural catheter, during her delivery.
´The catheter was removed 40 minutes after delivery. One hour later, the patient reported fluid leakage from the puncture site, which she noticed due to soilage of her clothes.
´The patient denied any headaches, photophobia, or neck stiffness. On physical exam, the nurse and anesthesia resident noted clear fluid leakage from the puncture site.
´An MRI of her lumbar spine revealed a 14cm subcutaneous fluid collection.
´After consulting with neurology, and discussing management options with the patient, the decision was made to suture the puncture site and apply a sterile dressing.
´The patient recovered without complications and was discharged home
Teaching Points:
´Rare but significant complication of neuraxial anesthesia
´Suspect CSF fistula with any persistent clear leakage from puncture site
´Symptoms may be minimal or absent → don’t rely on headache
´Early recognition is important to prevent complications including PDPH, meningitis, neurologic symptoms
´Diagnosis:
´Clinical suspicion + visible leakage
´Confirmation:
´Glucose, protein, beta-2 transferrin(most specific option, limited availability)
´Imaging – CT, MRI or MR myelography
´
´Management:
´Conservative:
´Pressure dressing, bed rest, skin adhesive, hydration.
´Theoretically, antibiotics(for meningitis prevention), acetazolamide(to decrease CSF production)
´Invasive
´Skin suture, epidural blood patch, surgical intervention