Idiopathic intracranial hypertension: Contemporary review and implications for the otolaryngologist

Stevens, Shawn M.; Rizk, Habib G.; Golnik, Karl C.; Andaluz, Norberto; Samy, Ravi N.; Meyer, Ted A.; Lambert, Paul R.

doi:10.1002/lary.26581

Cited by 58 publications

(57 citation statements)

References 113 publications

(372 reference statements)

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“…6 Classical clinical signs of IIH include headache and visual symptoms, such as transient obscurations, tinnitus, papilledema, and diplopia. 16 Yet most patients had only headaches as the leak likely provided a release valve of the increased ICP. An empty sella was the most common concurrent MRI finding, suggesting history of underlying increased ICP.…”

Section: Discussionmentioning

confidence: 99%

“…Nevertheless, some association does exist between IIH, lateral, and anterior skull base CSF leaks. 16 Recent studies have raised the possibility of obstructive sleep apnea as a risk factor for spontaneous CSF leaks. In a meta-analysis of three studies, patients with spontaneous CSF leaks were 2.85 times more likely than those with nonspontaneous CSF leaks to have obstructive sleep apnea (OSA).…”

Section: Discussionmentioning

confidence: 99%

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Surgical Outcomes and Postoperative Management in Spontaneous Cerebrospinal Fluid Rhinorrhea

et al. 2017

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The etiology of spontaneous cerebrospinal fluid (CSF) rhinorrhea remains unknown, though emerging evidence suggests that this likely represents a variant of idiopathic intracranial hypertension. Long-term success rates for repair and postoperative management strategies remain variable. Retrospective review of patients undergoing surgical management of spontaneous CSF rhinorrhea was conducted over a 5-year period. Analysis was performed to correlate recurrence with demographics and perioperative variables. Lumbar puncture usage and neuro-ophthalmological examinations in clinical management were also assessed. Forty-eight patients were included in the study. The mean age was 51.4 years with 94% females. Leaks were most commonly located in the sphenoid (43.8%) and cribriform region (33.3%). The most common findings on magnetic resonance imaging were empty sella (48%) and Meckel's cave diverticula (24%). Nine patients (18.8%) had recurrent CSF leaks. Six occurred >1 month postoperatively. Three had repeat endoscopic repairs, two received ventriculoperitoneal shunts, and one was managed with a lumbar drain, with overall success rate of 93.8%. Acetazolamide was utilized in 19 cases (39.6%) postoperatively. Overall, 59% of patients had elevated opening pressures on postoperative lumbar puncture ( = 32). Neuro-ophthalmology evaluated 28 patients; 25% had visual field deficits, and 7.1% had papilledema. Management of spontaneous CSF leaks remains a significant challenge. Endoscopic repair is successful in most patients with little morbidity; however, postoperative management remains inconsistent, and further studies are warranted to establish consensus on post-surgical care. The association with elevated intracranial pressure and visual field deficits/papilledema suggests opening pressures, and neuro-ophthalmologic evaluation should be considered in the treatment algorithm.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Surgical Outcomes and Postoperative Management in Spontaneous Cerebrospinal Fluid Rhinorrhea

et al. 2017

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“…Moreover, Banks etal.’s retrospective review demonstrated that BMI was statistically significantly higher in spontaneous CSF leaks compared to other CSF leak etiologies. Several authors note the concurrent increase of spontaneous CSF leaks (as well as IIH) in conjunction with the increasing obesity epidemic, although it is unclear if this could be increasing recognition and diagnosis of spontaneous CSF leaks …”

Section: Primary Csf Rhinorrheamentioning

confidence: 99%

ICAR: endoscopic skull‐base surgery

Wang

Zanation

Gardner

et al. 2019

Int Forum Allergy Rhinol

151

279

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Background Endoscopic skull‐base surgery (ESBS) is employed in the management of diverse skull‐base pathologies. Paralleling the increased utilization of ESBS, the literature in this field has expanded rapidly. However, the rarity of these diseases, the inherent challenges of surgical studies, and the continued learning curve in ESBS have resulted in significant variability in the quality of the literature. To consolidate and critically appraise the available literature, experts in skull‐base surgery have produced the International Consensus Statement on Endoscopic Skull‐Base Surgery (ICAR:ESBS). Methods Using previously described methodology, topics spanning the breadth of ESBS were identified and assigned a literature review, evidence‐based review or evidence‐based review with recommendations format. Subsequently, each topic was written and then reviewed by skull‐base surgeons in both neurosurgery and otolaryngology. Following this iterative review process, the ICAR:ESBS document was synthesized and reviewed by all authors for consensus. Results The ICAR:ESBS document addresses the role of ESBS in primary cerebrospinal fluid (CSF) rhinorrhea, intradural tumors, benign skull‐base and orbital pathology, sinonasal malignancies, and clival lesions. Additionally, specific challenges in ESBS including endoscopic reconstruction and complication management were evaluated. Conclusion A critical review of the literature in ESBS demonstrates at least the equivalency of ESBS with alternative approaches in pathologies such as CSF rhinorrhea and pituitary adenoma as well as improved reconstructive techniques in reducing CSF leaks. Evidence‐based recommendations are limited in other pathologies and these significant knowledge gaps call upon the skull‐base community to embrace these opportunities and collaboratively address these shortcomings.

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“…CSF production and its ow characteristics serve as a key component of the physiological homeostasis, immunological protection, and metabolic maintenance of the central nervous system. Perturbations of CSF homeostasis can result in pathological outcomes such as idiopathic intracranial hypertension (IIH), which often results in headaches and ocular pathologies [1,2]. Magnetic resonance imaging (MRI) studies in astronauts before and after space ight missions have shown perturbations to the CSF spaces, predominantly after long-duration missions, including narrowing of the central sulcus, upward shift of the brain, and narrowing of the CSF spaces at the vertex [3].…”

Section: Introductionmentioning

confidence: 99%

Quantification of Arterial, Venous, and Cerebrospinal Fluid Flow Dynamics by Magnetic Resonance Imaging Under Simulated Micro-Gravity Conditions: A Prospective Cohort Study

Zahid

Martin

Collins

et al. 2020

Preprint

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Abstract Background: Astronauts undergoing long-duration spaceflight are exposed to numerous health risks, including Spaceflight-Associated Neuro-Ocular Syndrome (SANS), a spectrum of ophthalmic changes that can result in permanent loss of visual acuity. The etiology of SANS is not well understood but is thought to involve changes in cerebrovascular flow dynamics in response to microgravity. There is a paucity of knowledge in this area; in particular, cerebrospinal fluid (CSF) flow dynamics have not been well characterized under microgravity conditions. Our study was designed to determine the effect of simulated microgravity (head-down tilt [HDT]) on cerebrovascular flow dynamics. We hypothesized that under microgravity conditions simulated by HDT, increased pressure in the intracranial space would alter intracranial CSF and venous flow dynamics by causing: 1) increased venous pressure reflected by increased venous cross-sectional area; and 2) a decrease in cardiac-related pulsatile CSF flow.Methods: In a prospective cohort study, we measured flow in major cerebral arteries, veins, and CSF spaces in fifteen healthy volunteers using phase contrast magnetic resonance (PCMR) before and during 15° HDT.Results: We found a significant increase in venous cross-sectional area with HDT (p=0.005), indicating increased venous pressure, along with a decrease in all CSF flow variables [systolic peak flow (p=0.009), and peak-to-peak pulse amplitude (p=0.001)]. Arterial average flow (p=0.04), systolic peak flow (p=0.04), and peak-to-peak pulse amplitude (p=0.02) all also significantly decreased.Conclusions: These results collectively demonstrate that acute application of 15° HDT caused a reduction in CSF flow variables (systolic peak flow and peak-to-peak pulse amplitude), coupled with an increase in venous CSA suggesting increased venous pressure with HDT.

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Idiopathic intracranial hypertension: Contemporary review and implications for the otolaryngologist

Cited by 58 publications

References 113 publications

Surgical Outcomes and Postoperative Management in Spontaneous Cerebrospinal Fluid Rhinorrhea

Surgical Outcomes and Postoperative Management in Spontaneous Cerebrospinal Fluid Rhinorrhea

ICAR: endoscopic skull‐base surgery

Quantification of Arterial, Venous, and Cerebrospinal Fluid Flow Dynamics by Magnetic Resonance Imaging Under Simulated Micro-Gravity Conditions: A Prospective Cohort Study

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