The Bone Mineral Density of the Lateral Skull Base and its Relation to Obesity and Spontaneous Cerebrospinal Fluid Leaks

Hatch, Jonathan L.; Schopper, Heather K.; Boersma, Isabel; Rizk, Habib G.; Nguyen, Shaun A.; Lambert, Paul R.; McRackan, Theodore R.; Meyer, Ted A.

doi:10.1097/mao.0000000000001969

Cited by 9 publications

(12 citation statements)

References 16 publications

(30 reference statements)

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“…A history of temporal bone trauma should raise suspicion for post-traumatic CSF leak, as demonstrated by Case 1. Conversely, a history of obesity, OSA and/or IIH should prompt further workup for sCSF-L (2–4,9–14,16–28,37). However, as demonstrated by cases 2 and 3, these demographic features need not be present for a patient to develop a “spontaneous” leak.…”

Section: Discussionmentioning

confidence: 97%

Cerebrospinal Fluid Leaks From the Lateral Ventricle: A Case Series

Saltagi

Fraser

Alwani

et al. 2021

Otology &Amp; Neurotology

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Objectives:Describe the diagnosis and management of lateral skull base (LSB) cerebrospinal fluid (CSF) leaks originating from the lateral ventricle.Study design:Retrospective case review.Setting:Tertiary referral academic center.Patients:Patients with CSF leaks with direct communication to the lateral ventricle on preoperative imaging.Intervention:Surgical repair via the middle cranial fossa (MCF) approach.Main outcome measures:CSF leak patient characteristics (age, sex, body mass index [BMI]) and postoperative course (complications and CSF leak resolution) were collected.Results:Three patients had CSF leaks from the lateral ventricle and all patients demonstrated encephalomalacia of the temporal lobe on preoperative imaging. Encephalomalacia resulted from trauma in one case (age 5) and neurodegeneration in two cases (age 77 and 84). BMI ranged from 16.3 to 26.6 mg/kg2 and follow-up ranged from 4 to 21 months. Two patients presented with preoperative meningitis and all patients had resolution of CSF leaks after MCF repair. With the exception of the higher rate of meningitis, patient presentations did not differ from other spontaneous CSF leaks through middle fossa defects. There were no minor or major postoperative complications.Conclusions:CSF leaks from the lateral ventricle represent a rare subset of LSB CSF leaks and can occur in non-obese patients secondary to temporal lobe encephalomalacia. The MCF approach allows for repair of the dura and skull base in this cohort of patients with high-flow CSF leaks and loss of brain parenchyma.

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Section: Discussionmentioning

confidence: 97%

Cerebrospinal Fluid Leaks From the Lateral Ventricle: A Case Series

Saltagi

Fraser

Alwani

et al. 2021

Otology &Amp; Neurotology

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“…Of the few previous tegmen measurement algorithms that have been reported, only one has focused on tegmen bone mineral density. 13 Our measurement algorithm is different from that one in that we designed ours to focus specifically on areas of potential pathophysiology. In contrast, previous algorithms have taken a broader measurement of the tegmen as a whole.…”

Section: Discussionmentioning

confidence: 99%

“…We did not find any significant differences in bone mineral density between obese and non-obese patients, in agreement with one previous quantitative study by Hatch et al from 2018, which reported no difference in bone mineral density of the lateral skull base as it relates to obesity or spontaneous CSF otorrhoea compared with normal-weight controls. 13 To date, the Hatch et al study remains the only published study on the quantitative analysis of tegmen bone mineral density.…”

Section: Discussionmentioning

confidence: 99%

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Quantitative analysis of tegmen bone mineral density in obese and non-obese patients

et al. 2021

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Background Certain factors have been linked to lateral skull base demineralisation or erosion, which may predispose to spontaneous cerebrospinal fluid leak. There are relatively few quantitative reports of skull base changes in patient populations. Method A novel refined measurement algorithm for quantification of tegmen bone mineral density was developed, and bone mineral density between obese and non-obese patient groups was compared. Computed tomography scans were analysed by three blinded reviewers, and tegmen bone mineral densities were compared. Results There were 23 patients in the obese group and 27 matched controls in the non-obese group. Inter-rater reliability was ‘strong’ to ‘near complete’ (κ = 0.75–0.86). No differences in tegmen bone mineral density were found between the groups (p = 0.64). The number of active blood pressure medications correlated positively with lateral skull base bone mineral density. Conclusion A novel, refined, quantitative measurement algorithm for the assessment of tegmen bone mineral density was developed and validated. Obesity was not found to significantly affect tegmen bone mineral density.

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“…11 More recently, increased attention has been paid to the effects of obesity on lateral skull base. 3,12-19…”

Section: Discussionmentioning

confidence: 99%

Is the Height of the Arcuate Eminence Related to Body Mass Index?

Coelho

Fasulo

Quinn

et al. 2020

Otolaryngol.--head neck surg.

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Objectives To determine the relationship, if any, between body mass index (BMI) and attenuation of the arcuate eminence (AE). Study Design Case series with chart review. Setting Tertiary neurotologic referral center. Subjects and Methods Submillimeter distances were recorded from high-resolution temporal bone computed tomography (CT) scans of 50 patients (100 sides). The AE (defined as the superiormost location of the petrous bone over the otic capsule), the bony apex of the superior semicircular canal (SSC), and the geniculate ganglion (GG) were identified and 3-dimensional distances measured. The height of the AE relative to the bony apex of the superior semicircular canal was determined using Euclidean geometry using the fixed anatomical landmark of the GG as the origin. Correlations between AE and BMI were calculated using Pearson’s, linear mixed effects, and sensitivity analysis models. Results The mean (SD) BMI was 30 (8.1) kg/m2, with 16 (30%) patients falling in the underweight/normal category (BMI <25 kg/m2), 10 (20%) overweight patients (25 kg/m2≤ BMI ≤ 30 kg/m2), and 24 (48%) patients considered obese (BMI >30 kg/m2). The mean (SD) AE heights for the left and right ears were 2.5 (1.11) and 2.6 (1.09), respectively. The results of the linear mixed-effects models indicated little evidence that BMI is associated with AE height when including all patients (partial R2 = 0.040) and when using BMI categories (partial R2 = 0.025). Conclusion Contrary to other structures within the lateral skull base, the relative prominence of the arcuate eminence does not correlate with BMI or any other demographic variables.

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The Bone Mineral Density of the Lateral Skull Base and its Relation to Obesity and Spontaneous Cerebrospinal Fluid Leaks

Cited by 9 publications

References 16 publications

Cerebrospinal Fluid Leaks From the Lateral Ventricle: A Case Series

Cerebrospinal Fluid Leaks From the Lateral Ventricle: A Case Series

Quantitative analysis of tegmen bone mineral density in obese and non-obese patients

Is the Height of the Arcuate Eminence Related to Body Mass Index?

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