Spontaneous Cerebrospinal Fluid Leaks: A Variant of Benign Intracranial Hypertension

Schlosser, Rodney J.; Woodworth, Bradford A.; Wilensky, Eileen Maloney; Grady, M. Sean; Bolger, William E.

doi:10.1177/000348940611500703

Cited by 201 publications

(239 citation statements)

References 14 publications

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“…18 In addition to the presence of an empty sella as a radiologic sign, 19 a common clinical constellation in patients with spontaneous CSF rhinorrhea is female sex, middle age, and obesity. 8,14,15,[18][19][20][21][22] Spontaneous CSF leaks have been postulated to represent a manifestation of benign intracranial hypertension 22 or pseudotumor cerebri. 23 Pulsatile-increased hydrostatic pressure is capable of bone erosion during the course of many years.…”

mentioning

confidence: 99%

Nontraumatic Skull Base Defects With Spontaneous CSF Rhinorrhea and Arachnoid Herniation: Imaging Findings and Correlation With Endoscopic Sinus Surgery in 27 Patients

Schuknecht¹,

Simmen²,

Briner³

et al. 2007

AJNR Am J Neuroradiol

142

135

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confidence: 99%

Nontraumatic Skull Base Defects With Spontaneous CSF Rhinorrhea and Arachnoid Herniation: Imaging Findings and Correlation With Endoscopic Sinus Surgery in 27 Patients

Schuknecht¹,

Simmen²,

Briner³

et al. 2007

AJNR Am J Neuroradiol

142

135

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“…Alternatively, obesity may predispose patients to increased postoperative complications. A strong association between obesity and increased intracranial pressure or idiopathic intracranial hypertension has been described, both of which impact perioperative CSF leak and longer hospital stays [17,18,19,20,21,22,23,24,25]. More recently, the risk of CSF leak was shown to be increased in patients with elevated BMI undergoing CPA surgery [3].…”

Section: Discussionmentioning

confidence: 99%

The Relation between Obesity and Hospital Length of Stay after Elective Lateral Skull Base Surgery: An Analysis of the American College of Surgeons National Surgical Quality Improvement Program

O’Connell

Rizk²,

Stevens³

et al. 2015

ORL

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Purpose: Length of stay is a marker of quality and efficiency of health care delivery. The objective of this study was to identify preoperative, intraoperative, and postoperative variables that impact length of stay after lateral skull base surgery. Methods/Procedures: The American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) databases from 2009-2012 were analyzed, and patients undergoing elective lateral skull base surgery for benign lesions of cranial nerves were identified. The primary outcome measure of interest was length of hospital stay. Protracted length of stay was defined as ≥75th percentile of length of stay for all patients. The impact of demographic factors, intraoperative variables, and postoperative complications on length of stay was assessed. Results: In total, 252 patients were included. Almost half of the patients (41.2%) were classified as obese (body mass index ≥30). Patients who were obese had significantly longer lengths of stay (5.6 ± 3.9 days) when compared to patients who were not obese (4.6 ± 3.4 days, p = 0.006). Multivariate regression analysis demonstrated that operative time, reoperation within 30 days of initial surgery, and obesity were independent predictors for protracted length of stay. Conclusion: National multi-institutional data from the ACS-NSQIP suggest that operative time, reoperation, and obesity are predictors of longer hospital stays after lateral skull base approaches for benign cranial nerve neoplasms.

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“…Causes of acquired MFFD include trauma, inflammatory conditions, malignancy, and radiotherapy. 12 Many theories account for the origin of spontaneous MFFD, including excessive resorption of bone by normal-pressure CSF pulsation, 16 which can be associated with high-pressure CSF pulsation in benign intracranial hypertension, 18 and dehiscence that occurs during pneumatization of the middle ear and mastoid air cells. 19 In surgery, a variety of MFFD pathologies are encountered, with variation in the extent of bone disease and involvement of the dura mater and brain parenchyma.…”

Section: Discussionmentioning

confidence: 99%

Classification of middle fossa floor dehiscence syndromes

Gupta

Sabry

Doğan

et al. 2015

JNS

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Middle fossa floor dehiscence (MFFD) has distinctly different presentations that include a range of syndromes and clinical symptoms. Middle fossa floor compromise can be spontaneous or occur secondary to accompanying disease processes, such as trauma, otitis media, inflammation, malignancy, cholesteatoma, and radiation therapy. The etiopathogenesis of spontaneous MFFD is widely debated, and several theories have been proposed. Spontaneous anterior cranial floor dehiscence and CSF leakage have been associated with empty sella syndrome and benign intracranial hypertension.18 These factors are similarly associated with a female predominance and an increased body mass index (BMI), which have also been associated with MFFD. 3,5,9,12 Other proposed hypotheses include congenital erosion of the middle fossa floor during pneumatization of the middle ear and mastoid air cells, 14,19 as well as atrophy over years of normal CSF pulsation.16 Surgical repair has been described 7,12,13 and includes a range of procedures involving resection of the encephalocele, dural repair, and plugging of the bony dehiscence.A wide range of clinical presentations has been de- obJect Middle fossa floor dehiscence (MFFD) can present as multiple syndromes depending on dehiscence location, tissue herniation, and dural integrity. The authors propose a classification system for MFFD with the potential to guide clinical decision making. methods A retrospective analysis of the electronic medical records (years 1995-2012) of patients who had undergone temporal craniotomy for the surgical repair of an MFFD syndrome at a single institution was undertaken. Reviewed data included demographic, operative, presentation, and outcome details. Middle fossa floor dehiscence was classified as follows: Class A, bony dehiscence without herniation of the brain and/or meninges; Class B, herniation of the brain and/or meninges through the middle fossa floor without CSF leakage; Class C, dehiscence with CSF leakage without meningitis; or Class D, dehiscence with meningitis. results Fifty-one patients, 22 males and 29 females, were included in the analysis. The mean age was 48.7 ± 15.5 years, mean body mass index was 32.65 ± 6.86 kg/m 2 , and mean symptom duration was 33 ± 42 months. Seven patients underwent repeat surgery for symptomatic recurrence; therefore, there were 58 surgical encounters. Repair included bony reconstruction with hydroxyapatite with or without resection of encephaloceles and/or repair of a dural defect. According to the MFFD classification system described, 15, 8, 27, and 8 cases were categorized as Class A, B, C, and D, respectively. The prevalence of hearing loss was 87%, 63%, and 70% in Classes A, B, and C, respectively. Vestibular symptoms were more prevalent in Class A. Seven patients reported persistent symptoms at the last follow-up. Transient complications were similar in each classification (13%-25%), and a single permanent complication related to anesthesia was observed. There were no mortalities or severe neurological morbidities in th...

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Spontaneous Cerebrospinal Fluid Leaks: A Variant of Benign Intracranial Hypertension

Cited by 201 publications

References 14 publications

Nontraumatic Skull Base Defects With Spontaneous CSF Rhinorrhea and Arachnoid Herniation: Imaging Findings and Correlation With Endoscopic Sinus Surgery in 27 Patients

Nontraumatic Skull Base Defects With Spontaneous CSF Rhinorrhea and Arachnoid Herniation: Imaging Findings and Correlation With Endoscopic Sinus Surgery in 27 Patients

The Relation between Obesity and Hospital Length of Stay after Elective Lateral Skull Base Surgery: An Analysis of the American College of Surgeons National Surgical Quality Improvement Program

Classification of middle fossa floor dehiscence syndromes

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