Spontaneous cerebrospinal fluid leak repair: A five-year prospective evaluation

Authors

  • Mohamad R. Chaaban MD,

    1. Department of Surgery, Division of Otolaryngology–Head and Neck Surgery, University of Alabama at Birmingham, Birmingham, Alabama, U.S.A
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  • Elisa Illing MD,

    1. Department of Surgery, Division of Otolaryngology–Head and Neck Surgery, University of Alabama at Birmingham, Birmingham, Alabama, U.S.A
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  • Kristen O. Riley MD,

    1. Division of Neurosurgery, University of Alabama at Birmingham, Birmingham, Alabama, U.S.A
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  • Bradford A. Woodworth MD

    Corresponding author
    1. Department of Surgery, Division of Otolaryngology–Head and Neck Surgery, University of Alabama at Birmingham, Birmingham, Alabama, U.S.A
    • Send correspondence to Bradford A. Woodworth, MD, BDB 563, 1720 2nd Ave. South, Birmingham, AL 35294. E-mail: bwoodwo@hotmail.com

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  • Presented at the Triological Society Combined Sections Meeting, Scottsdale, Arizona, U.S.A., January 24–26, 2013.

  • Bradford A. Woodworth, MD, is a consultant for ArthroCare ENT and Olympus.

  • The authors have no other funding, financial relationships, or conflicts of interest to disclose.

Abstract

Objectives/Hypothesis

Mounting evidence indicates the majority of spontaneous cerebrospinal fluid (CSF) leaks are associated with intracranial hypertension. The objectives of the current study were to assess outcomes regarding spontaneous CSF leaks focusing on premorbid factors, surgical technique, and management of intracranial pressure.

Study Design

Prospective cohort.

Methods

Prospective evaluation of patients with spontaneous CSF leaks was performed. Data regarding demographics, nature of presentation, body mass index (BMI), location and size of defect, intracranial pressure, clinical follow-up, and complications were collected.

Results

Over 5 years, 46 patients (average age, 51 years) with 56 spontaneous CSF leaks were treated by a single otolaryngologist. Twenty-one subjects presented with recurrence of their CSF leak following previous endoscopic and/or open approaches by other physicians. Obesity was present in 78% of individuals (average BMI, 35.6). Fifty-two CSF leaks (93%) were successfully repaired at first attempt. With secondary repair, all CSF leaks were closed at last clinical follow-up (average, 93 weeks). Three patients developed late failures (>2 months), with one recurrence at a distinct location from the primary site at 8 months postprocedure (associated with ventriculoperitoneal shunt failure). Opening pressures via lumbar puncture averaged 24.3 ± 8.3 cm H20, which increased significantly to 32.3 ± 9.0 cm H20 (P < .0001) following closure of the skull base defect(s). Management of intracranial hypertension included acetazolamide (n = 23) or permanent CSF diversion (n = 19, including five revisions of failed preexisting shunts).

Conclusions

Although spontaneous CSF leaks have the highest recurrence rate of any etiology, prospective evaluation demonstrates high success rates with control of intracranial hypertension.

Level of Evidence

4. Laryngoscope, 124:70–75, 2014

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