title: Spontaneous CSF leaks: a paradigm for definitive repair and management of intracranial hypertension.
abstract: OBJECTIVE
  To report our outcomes with the repair of spontaneous cerebrospinal fluid (CSF) leaks and to demonstrate how management of underlying intracranial hypertension improves outcomes.
  
  
  METHODS
  Retrospective review of spontaneous CSF leaks treated at the University of Pennsylvania Health System from 1996 to 2006. Data collected included demographics, nature of presentation, body mass index (BMI), site of skull base defect, surgical approach, intracranial pressure, and clinical follow-up.
  
  
  RESULTS
  Fifty-six patients underwent repair of spontaneous CSF leaks. Eighty-two percent (46 of 56) were obese (average BMI 36.2 kg/m(2)). Nine patients had multiple CSF leaks. Fifty-four patients (96%) had associated encephaloceles. Fifty-three CSF leaks (95%) were successfully repaired at first attempt (34 months of follow-up). Intracranial pressures averaged 27 cm H(2)O. Patients were treated with acetazolamide or, in severe cases, with a ventriculoperitoneal shunt.
  
  
  CONCLUSIONS
  Spontaneous CSF leaks have the highest recurrence rate of any etiology. With treatment of underlying intracranial hypertension coupled with endoscopic repair, the success rate (95%) approaches that of other etiologies of CSF leaks.
authors.affiliation: Department of Otorhinolaryngology-Head and Neck Surgery, University of Pennsylvania Health System, Philadelphia, PA 19104-4206, USA.
authors.forename: Bradford A
authors.initials: BA
authors.lastname: Woodworth
authors.forename: Anthony
authors.initials: A
authors.lastname: Prince
authors.forename: Alexander G
authors.initials: AG
authors.lastname: Chiu
authors.forename: Noam A
authors.initials: NA
authors.lastname: Cohen
authors.forename: Rodney J
authors.initials: RJ
authors.lastname: Schlosser
authors.forename: William E
authors.initials: WE
authors.lastname: Bolger
authors.forename: David W
authors.initials: DW
authors.lastname: Kennedy
authors.forename: James N
authors.initials: JN
authors.lastname: Palmer
mesh_terms: D000328:Adult; D000368:Aged; D002559:Cerebrospinal Fluid Rhinorrhea / Q000209:etiology / Q000503:physiopathology* / Q000601:surgery; D015331:Cohort Studies; D004652:Empty Sella Syndrome / Q000150:complications / Q000503:physiopathology / Q000601:surgery; D004677:Encephalocele / Q000150:complications / Q000503:physiopathology* / Q000601:surgery; D004724:Endoscopy; D005260:Female; D006801:Humans; D019586:Intracranial Hypertension / Q000150:complications / Q000503:physiopathology / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D016896:Treatment Outcome