title: Perioperative continuous cerebrospinal fluid pressure monitoring in patients with spontaneous cerebrospinal fluid leaks.
abstract: BACKGROUND
  Elevated intracranial pressure (ICP) is an inciting factor for cerebrospinal fluid (CSF) leaks and can be measured by CSF pressure (CSFP) monitoring. Current CSFP literature is limited to the assessments of opening pressure. This study reinvestigates a previously discussed monitoring approach that evaluates continuous CSFP parameters, physiologic measurements, and treatment outcomes in patients undergoing endoscopic repair of spontaneous CSF leaks.
  
  
  METHODS
  Retrospective review of patients undergoing endoscopic endonasal repair of spontaneous CSF leaks. All participants had a lumbar catheter placed for 24-hour continuous preoperative pressure monitoring, and 24 hours of continuous monitoring starting 48 hours after repair. In addition to patient characteristics, mean and peak CSFP, pulse waveform amplitudes (PWAs), and related parameters were calculated.
  
  
  RESULTS
  Twenty-five patients underwent monitoring between 2004 and 2013, with a mean follow-up of 526 days. The mean age was 49.2 years, the mean body mass index (BMI) 38.5, and 8 of 25 (32%) had obstructive sleep apnea. Although mean CSFP and PWA decreased after the repair, mean peak CSFP increased by 1.56 cmH2O (1.15 mmHg). Six patients (24%) had elevation in their CSFP >25 cmH2O (18.4 mmHg) for a minimum of 4% of the recording time. Based on their continuous pressure monitoring data, 9 patients (36%) underwent treatment for high ICP, either with acetazolamide or a ventricular shunt. There were no CSF leak recurrences.
  
  
  CONCLUSIONS
  Continuous perioperative CSFP monitoring provides valuable insight into multiple physiologic parameters. Systematic continuous CSFP monitoring can identify individuals in need of ICP-lowering therapy, possibly improving the outcomes in CSF leak repair surgeries.
authors.affiliation: Johns Hopkins School of Medicine, Baltimore, MD.
authors.forename: Yanjun J
authors.initials: YJ
authors.lastname: Xie
authors.forename: Josef
authors.initials: J
authors.lastname: Shargorodsky
authors.forename: Andrew P
authors.initials: AP
authors.lastname: Lane
authors.forename: Masaru
authors.initials: M
authors.lastname: Ishii
authors.forename: David
authors.initials: D
authors.lastname: Solomon
authors.forename: Abhay
authors.initials: A
authors.lastname: Moghekar
authors.forename: Gary L
authors.initials: GL
authors.lastname: Gallia
authors.forename: Douglas D
authors.initials: DD
authors.lastname: Reh
mesh_terms: D057785:Catheters / Q000706:statistics & numerical data; D015170:Cerebrospinal Fluid Pressure / Q000502:physiology; D002559:Cerebrospinal Fluid Rhinorrhea / Q000175:diagnosis* / Q000601:surgery; D004724:Endoscopy; D006801:Humans; D008875:Middle Aged; D008991:Monitoring, Physiologic / Q000379:methods; D059035:Perioperative Period; D063177:Pulse Wave Analysis; D019651:Plastic Surgery Procedures; D012189:Retrospective Studies; D016896:Treatment Outcome
keywords: cerebrospinal fluid leak; cerebrospinal fluid rhinorrhea; endoscopic skull base surgery; idiopathic intracranial hypertension; intracranial pressure monitoring