Intervention for elevated intracranial pressure improves success rate after repair of spontaneous cerebrospinal fluid leaks

Teachey, William; Grayson, Jessica W.; Cho, Do‐Yeon; Riley, Kristen; Woodworth, Bradford A.

doi:10.1002/lary.26612

Cited by 132 publications

(94 citation statements)

References 69 publications

(100 reference statements)

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“…Spontaneous CSF leaks have a higher postoperative recurrence rate than other types of CSF leaks, the cause of which some authors presume to be the elevated ICPs . A recent study showed that in patients undergoing operative repair of CSF leak, postoperative acetazolamide decreased recurrence rate by 11% . In our clinical experience, a subset of patients with spontaneous CSF leaks pretreated with acetazolamide have not required surgery.…”

mentioning

confidence: 56%

Preoperative management of spontaneous cerebrospinal fluid rhinorrhea with acetazolamide

Tilak

Koehn

Mattos

et al. 2018

Int Forum Allergy Rhinol

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Background: Spontaneous cerebrospinal fluid (CSF) rhinorrhea has been associated with elevated intracranial pressure (ICP). As such, ICP reducing measures are commonly employed to optimize repair. Although postoperative acetazolamide use has been described, no data currently exists on the potential for preoperative use. Methods:A retrospective review was performed including patients treated for anterior spontaneous CSF leaks by a single surgeon over a 6-year period during which acetazolamide therapy (250 mg twice daily) was employed before considering surgical repair. The primary endpoint was whether the patient went on to require surgical repair.Results: A total of 16 patients were identified who were pretreated with acetazolamide. Leak sites were noted as cribriform (5/16), sphenoid (8/16), ethmoid (1/16), multiple (1/16), and indeterminate (1/16). Five patients had resolution of their rhinorrhea without surgery (31.3%). Mean follow-up for these nonsurgical patients was 470 days (range, 64 to 857 days). There were no differences in the patients' age or site of leak between surgical and nonsurgical patients (p = 0.65, p = 0.52, respectively). Nonsurgical patients had a lower body mass index (BMI) than surgical patients (p = 0.04).Conclusion: This is the first study to report the use of acetazolamide therapy as a primary treatment option for spontaneous CSF rhinorrhea. This therapy enabled surgery to be avoided in 31.3% of patients. This would indicate that in the absence of other contraindications for delaying repair, a trial of acetazolamide therapy could be considered as an initial option in the management of isolated spontaneous CSF rhinorrhea. C 2018 ARS-AAOA, LLC. How to Cite thisArticle: Tilak AM, Koehn H, Ma os J, Payne SC. Preoperative management of spontaneous cerebrospinal fluid rhinorrhea with acetazolamide. Int Forum Allergy Rhinol. 2019;9:265-269. h ps://doi.org/10.1002/alr.22245C ranial cerebrospinal fluid (CSF) leaks represent an escape of the CSF through the dura combined with a defect in the overlying bone and a pressure gradient allowing flow through the defects. 1, 2 The most common etiology of CSF leak is traumatic in origin, whether iatrogenic during surgery or from some other external collision or force. Another population of CSF leaks occur spontaneously and have been associated with idiopathic intracranial hypertension (IIH), in which abnormal or relatively decreased resorption of CSF by arachnoid villi leads to increased in-

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confidence: 56%

Preoperative management of spontaneous cerebrospinal fluid rhinorrhea with acetazolamide

Tilak

Koehn

Mattos

et al. 2018

Int Forum Allergy Rhinol

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“…Teachey et al performed a systemic review comparing successful closure of anterior skull base CSF fistula between patients who had active versus no management of elevated ICP. The success rate for the actively managed group was 92.8% compared to 81.9% for the group that did not undergo management of elevated ICP ( P < .001) . Although there are no comparable studies for lateral skull base CSF fistula, it could be assumed treatment of elevated ICP will result in fewer recurrences.…”

Section: Discussionmentioning

confidence: 94%

“…The success rate for the actively managed group was 92.8% compared to 81.9% for the group that did not undergo management of elevated ICP (P <.001). 38 Although there are no comparable studies for lateral skull base CSF fistula, it could be assumed treatment of elevated ICP will result in fewer recurrences.…”

Section: Long-term Management Of Elevate Intracranial Pressurementioning

confidence: 99%

Surgical management of spontaneous cerebrospinal fistulas and encephaloceles of the temporal bone

2018

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“…Of note, other mechanisms may be involved, such as transverse sinus stenosis . In anterior skull‐base CSF leak, it has been shown that the management of elevated ICP improved the success rate of surgical closure of the leak . This seems to be different in temporal bone CSF leak: the relatively high success rates obtained with a strategy that did not include information on ICP suggest that the duraplasty may be more reliable in temporal bone than in anterior skull‐base defects.…”

Section: Discussionmentioning

confidence: 99%

Surgical management of spontaneous temporal bone cerebrospinal fluid leaks: Results of a strategy based on defect location. A bicentric retrospective study of 44 cases

Brenet

Dubernard

Kleiber

et al. 2019

Clinical Otolaryngology

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Intervention for elevated intracranial pressure improves success rate after repair of spontaneous cerebrospinal fluid leaks

Abstract: 4. Laryngoscope, 127:2011-2016, 2017.

Cited by 132 publications

References 69 publications

Preoperative management of spontaneous cerebrospinal fluid rhinorrhea with acetazolamide

Preoperative management of spontaneous cerebrospinal fluid rhinorrhea with acetazolamide

Surgical management of spontaneous cerebrospinal fistulas and encephaloceles of the temporal bone

Surgical management of spontaneous temporal bone cerebrospinal fluid leaks: Results of a strategy based on defect location. A bicentric retrospective study of 44 cases

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