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Spontaneous CSF leaks: Factors predictive of additional interventions§

Authors

  • Rahul Seth MD,

    1. Head and Neck Institute, Cleveland Clinic Foundation, Cleveland, Ohio, U.S.A.
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  • Karthik Rajasekaran III MS,

    1. Chicago Medical School at Rosalind Franklin, University of Medicine and Science, North Chicago, Illinois, U.S.A.
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  • Amber Luong MD, PhD,

    1. Department of Otorhinolaryngology–Head & Neck Surgery, University of Texas Medical School at Houston, Houston, Texas, U.S.A.
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  • Michael S. Benninger MD,

    1. Head and Neck Institute, Cleveland Clinic Foundation, Cleveland, Ohio, U.S.A.
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  • Pete S. Batra MD

    Corresponding author
    1. Department of Otolaryngology–Head and Neck Surgery and Comprehensive Skull Base Program, University of Texas Southwestern Medical Center, Dallas, Texas, U.S.A.
    • Comprehensive Skull Base Program, Department of Otolaryngology–Head and Neck Surgery, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd., Dallas, TX 75390.
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  • This work was presented as an oral presentation at the Annual American Rhinological Society Meeting on October 3, 2009, in San Diego, CA, U.S.A.

  • Conflicts of interest: P.S.B. Medtronic (consultant), LifeCell (consult), NeilMed (consultant), Xoran (grant), Karl Storz (speaker's bureau), MedInvent (grant). All other authors declare no conflicts of interst.

  • §

    The authors have no financial disclosures for this article.

Abstract

Objective:

Spontaneous cerebrospinal fluid (CSF) leaks represent a significant challenge due to frequent association with elevated intracranial pressure (ICP) and higher risk of surgical failure. The study objective was to review management strategy and identify factors associated with need for acetazolamide and/or ventriculoperitoneal shunt (VPS) placement.

Study Design:

Retrospective data analysis.

Methods:

Chart review performed from 1999 to 2009 at a tertiary-care medical center.

Results:

A total of 105 patients underwent CSF leak repair; 39 patients (37.1%) were treated for spontaneous CSF leaks. Mean age was 57.7 years and 33 were female (85%). Average body mass index (BMI) was 38.5 kg/m2. The most common sites were cribriform plate (51%), sphenoid lateral pterygoid recess (31%), and ethmoid roof (8%). All patients underwent endoscopic repair utilizing image guidance with multilayered closure in most cases. Five patients (12.8%) developed recurrent CSF leak with mean ICP of 27.0 cm H2O, compared to 25.0 cm H2O for those without recurrence (P = .33). All had successful rerepair at mean follow-up of 2.8 years. Acetazolamide was used in nine patients, whereas six patients underwent VPS placement for elevated ICP management. Diagnosis of benign intracranial hypertension (BIH) was statistically associated with need for acetazolamide or VPS (P < .001), whereas elevated ICP reached borderline significance (P = .049).

Conclusions:

Management of spontaneous CSF leaks requires a comprehensive strategy after endoscopic repair. Diagnosis of BIH may be associated with requirement of further ICP treatment. Close ICP monitoring, coupled with selective use of acetazolamide and VPS, may decrease risk of failure. Laryngoscope, 2010

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