Objective: Determine if patients with increased opening pressure (OP) on lumbar puncture (LP) have thinner calvaria and skull bases. Study Design: Retrospective cohort study. Setting: Tertiary referral center. Patients: Patients (≥18 yr of age) who had a recorded OP on LP and high-resolution computed tomography imaging of the head. Patient age, sex, body mass index were calculated. Intracranial hypertension (IH) was defined with an OP≥25 cm-H2O and low intracranial pressure with an OP<15 cm-H2O. Intervention: Measurement of calvarial, zygoma, and skull base thickness when blinded to OP with three-dimensional slicer and radiologic calipers. Main Outcome Measures: Association of calvarial, skull base, and zygoma thickness with OP and age. Results: Fifty-eight patients were included with a mean (SD) age of 53.1 (16.2) years and average (SD) body mass index of 30.1 (9.1) kg/m2. Patients with IH had thinner mean (SD) calvaria (3.01 [0.81] versus 2.70 [0.58] mm; p = 0.036) and skull bases (5.17 [1.22] versus 4.60 [1.42] mm; p = 0.043) when compared with patients without IH. The mean (SD) extracranial zygoma thickness was similar between the two groups (5.09 [0.76] versus 5.00 [0.73] mm; p = 0.56). General linear model regression demonstrated advancing age was associated with increasing calvarial thickness in patients without IH and calvarial thinning in patients with IH (p = 0.038). Conclusion: IH is independently associated with intracranial bone (calvaria and skull base) thinning and not extracranial (zygoma) thinning. Skull thinning occurs with IH and advancing age. These findings support a possible role of increased ICP in the pathophysiologic development of spontaneous cerebrospinal fluid leaks.
Objectives/Hypothesis To conduct longitudinal postoperative follow‐up and discern health‐related quality‐of‐life (HR‐QoL) changes using a validated questionnaire among patients undergoing head and neck surgeries during a short‐term, global surgical trip in a resource‐limited setting. To identify clinicodemographic predictors of post‐operative HR‐QoL improvements in this setting. Study Design Retrospective observational study with prospective follow‐up. Methods Patients undergoing surgery at Moi Teaching and Referral Hospital in Eldoret, Kenya through the authors' short‐term surgical trip (STST) between 2016 and 2019 were asked to complete preoperative Short Form‐36 (SF‐36) HR‐QoL questionnaires, and postoperative SF‐36 questionnaires during subsequent follow‐up. Preoperative and postoperative SF‐36 domain scores, and two composite scores (mental component summary [MCS] and physical component summary [PCS]) were compared. Linear regression models were fit to identify clinicodemographic factors predictors of general health (GH), MCS, and PCS scores. Results Among the 26 participating patients, significant improvements were seen in post‐operative GH (mean change = 19.8) and MCS (mean change = 11.2) scores. Lower pre‐operative GH, MCS, and PCS scores were predictive of greater improvement in the corresponding post‐operative scores. Longer time to follow‐up was associated with greater improvement in GH score. Mean follow‐up interval was 23.1 months (SD = 1.8 months). Conclusions Utilizing the SF‐36 questionnaire, we found that patients' perception of their general and psychosocial health improved after undergoing head and neck surgeries through a global STST. This study provides important, preliminary evidence that that elective surgeries performed in low‐resource settings convey substantial benefit to patient QoL. Level of Evidence 4 Laryngoscope, 131:2006–2010, 2021
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