Spontaneous CSF leaks: factors predictive of additional interventions.
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.


METHODS
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/m(2). 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 H(2)O, compared to 25.0 cm H(2)O 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.
Head and Neck Institute, Cleveland Clinic Foundation, Cleveland, Ohio, USA.
Rahul
R
Seth
Karthik
K
Rajasekaran
Amber
A
Luong
Michael S
MS
Benninger
Pete S
PS
Batra
D000086:Acetazolamide / Q000627:therapeutic use*; D000368:Aged; D000465:Algorithms; D015170:Cerebrospinal Fluid Pressure; D002559:Cerebrospinal Fluid Rhinorrhea / Q000188:drug therapy* / Q000209:etiology / Q000601:surgery*; D003131:Combined Modality Therapy; D004652:Empty Sella Syndrome / Q000150:complications; D004724:Endoscopy / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D019586:Intracranial Hypertension / Q000150:complications; D008297:Male; D008875:Middle Aged; D008991:Monitoring, Physiologic / Q000379:methods; D012008:Recurrence; D018570:Risk Assessment; D012720:Severity of Illness Index; D016896:Treatment Outcome; D017287:Ventriculoperitoneal Shunt / Q000009:adverse effects / Q000379:methods*
D000086:Acetazolamide