title: The rising incidence of spontaneous cerebrospinal fluid leaks in the United States and the association with obesity and obstructive sleep apnea.
abstract: OBJECTIVE
  To determine the national rates of spontaneous CSF leaks and to determine the association with risk factors.
  
  
  METHODS
  Retrospective review from 2002 to 2012.
  
  
  METHODS
  University HealthSystem Consortium (UHC) database of 127 of the leading academic medical centers in the United States (81 centers participated all years of the study).
  
  
  METHODS
  Those who underwent craniotomy for CSF leak repair in the UHC database and those who have undergone repair of spontaneous CSF leaks at one UHC center.
  
  
  METHODS
  Assessment of procedure code rates and patient demographics from 2002 to 2012.
  
  
  METHODS
  National rates of craniotomy for spontaneous CSF leak repair each year, the relation to U.S. regional obesity rates, and the proportion of patients with coincident obstructive sleep apnea. Spontaneous CSF leak patient characteristics (age, sex, BMI, hypertension, and OSA) were calculated.
  
  
  RESULTS
  The rate of craniotomy for spontaneous CSF leak repair has risen 2 fold from 2002 (218 cases per year) to 2012 (488 cases per year). There was no change in the rate of nonspontaneous CSF leaks over the same period. The rate of spontaneous CSF leak repair is twice as high (2.54 versus 1.07 per million people per year) in regions of the United States with the highest obesity rate (Midwest) compared with the lowest obesity rate (West). All patients with spontaneous CSF leaks were overweight (BMI, >25 kg/m2) with an average BMI of 37.8 kg/m2. The average age was 57.03 years, and 72% were female. Patients with spontaneous CSF leaks presented with high rate of OSA (14.8% nationally and 37.1% at the University of Iowa) and hypertension (85.7%).
  
  
  CONCLUSIONS
  The national rate of craniotomy for spontaneous CSF leak repair is rising. This condition is yet another public health problem related to the rising obesity epidemic. All patients with spontaneous CSF leaks should be evaluated for OSA.
authors.affiliation: *Department of Otolaryngology-Head and Neck Surgery, Indiana University, Indianapolis, Indiana; and Departments of †Otolaryngology-Head and Neck Surgery, and ‡Neurosurgery, University of Iowa, Iowa City, Iowa, U.S.A.
authors.forename: Rick F
authors.initials: RF
authors.lastname: Nelson
authors.forename: Bruce J
authors.initials: BJ
authors.lastname: Gantz
authors.forename: Marlan R
authors.initials: MR
authors.lastname: Hansen
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015992:Body Mass Index; D065634:Cerebrospinal Fluid Leak / Q000453:epidemiology* / Q000601:surgery; D002648:Child; D015897:Comorbidity; D003399:Craniotomy; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D009765:Obesity / Q000453:epidemiology*; D012189:Retrospective Studies; D012307:Risk Factors; D020181:Sleep Apnea, Obstructive / Q000453:epidemiology*; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology; D055815:Young Adult