title: Increased intracranial pressure in spontaneous CSF leak patients is not associated with papilledema.
abstract: OBJECTIVE
  Spontaneous cerebrospinal fluid (CSF) leaks typically present in patients with undiagnosed idiopathic intracranial hypertension (IIH) secondary to pressure erosion of the skull base. Despite elevated intracranial pressure (ICP) on lumbar puncture or ventriculostomy, patients with spontaneous CSF leaks rarely complain of visual disturbances. The objective of this study is to correlate the presence of preoperative papilledema with opening ICP in patients undergoing endoscopic repair of spontaneous CSF leaks.
  
  
  METHODS
  Prospective study.
  
  
  METHODS
  Tertiary hospital.
  
  
  METHODS
  Prospective evaluation of patients with spontaneous CSF leaks was performed over a 1-year period (December 2012 to December 2013). Fundoscopic examination for papilledema was completed preoperatively and CSF pressure measured by lumbar puncture or ventriculostomy intraoperatively. Data regarding demographics, nature of presentation, and body mass index (BMI) were also recorded and compared to a control cohort of IIH patients with papilledema.
  
  
  RESULTS
  Sixteen patients (average age 52) were evaluated. Obesity was present in 94% of individuals (average BMI = 43, range, 27-65). Papilledema was absent preoperatively in all subjects. Opening pressures via lumbar puncture/ventriculostomy were 27.4 ± 7.7 cmH20. Following 6 hours of clamping, measurements significantly increased to 36 ± 9.6 cmH20 (P < .001). IIH controls (average age 33, average BMI = 36, range, 21-52) exhibited average ICP (36.2 ± 11.7) identical to postclamp measurements in the spontaneous CSF leak cohort.
  
  
  CONCLUSIONS
  Subjects with spontaneous CSF leaks had postclamping average ICP identical to controls with IIH and papilledema. Such evidence suggests that a CSF leak in this patient population provides sufficient pressure diversion to avoid the development of papilledema.
authors.affiliation: Departments of Surgery/Division of Otolaryngology, University of Alabama at Birmingham, Birmingham, Alabama, USA.
authors.forename: Geoffrey
authors.initials: G
authors.lastname: Aaron
authors.affiliation: Department of Opthalmology, University of Alabama at Birmingham, Birmingham, Alabama, USA.
authors.forename: Jennifer
authors.initials: J
authors.lastname: Doyle
authors.affiliation: Department of Opthalmology, University of Alabama at Birmingham, Birmingham, Alabama, USA.
authors.forename: Michael S
authors.initials: MS
authors.lastname: Vaphiades
authors.affiliation: Department of Neurosurgery, University of Alabama at Birmingham, Birmingham, Alabama, USA.
authors.forename: Kristen O
authors.initials: KO
authors.lastname: Riley
authors.affiliation: Departments of Surgery/Division of Otolaryngology, University of Alabama at Birmingham, Birmingham, Alabama, USA bwoodwo@hotmail.com.
authors.forename: Bradford A
authors.initials: BA
authors.lastname: Woodworth
mesh_terms: D000328:Adult; D000367:Age Factors; D016022:Case-Control Studies; D065634:Cerebrospinal Fluid Leak / Q000175:diagnosis / Q000453:epidemiology* / Q000601:surgery*; D002557:Cerebrospinal Fluid Shunts / Q000379:methods; D015897:Comorbidity; D004724:Endoscopy / Q000009:adverse effects / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006785:Hospitals, University; D006801:Humans; D019586:Intracranial Hypertension / Q000175:diagnosis / Q000453:epidemiology* / Q000601:surgery; D008279:Magnetic Resonance Imaging / Q000379:methods; D008297:Male; D008875:Middle Aged; D009887:Ophthalmoscopy / Q000379:methods; D010211:Papilledema / Q000175:diagnosis* / Q000453:epidemiology; D011183:Postoperative Complications / Q000453:epidemiology / Q000503:physiopathology; D011300:Preoperative Care / Q000379:methods; D011446:Prospective Studies; D018570:Risk Assessment; D012720:Severity of Illness Index; D012737:Sex Factors; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D055815:Young Adult
keywords: CSF leak; acetazolamide; benign intracranial hypertension; cerebrospinal fluid; idiopathic intracranial hypertension; papilledema; pseudotumor cerebri; shunt; spontaneous CSF leak