TY - JOUR
T1 - Spontaneous CSF leaks
T2 - A paradigm for definitive repair and management of intracranial hypertension
AU - Woodworth, Bradford A.
AU - Prince, Anthony
AU - Chiu, Alexander G.
AU - Cohen, Noam A.
AU - Schlosser, Rodney J.
AU - Bolger, William E.
AU - Kennedy, David W.
AU - Palmer, James N.
PY - 2008/6
Y1 - 2008/6
N2 - Objective: To report our outcomes with the repair of spontaneous cerebrospinal fluid (CSF) leaks and to demonstrate how management of underlying intracranial hypertension improves outcomes. Study Design: Retrospective review of spontaneous CSF leaks treated at the University of Pennsylvania Health System from 1996 to 2006. Data collected included demographics, nature of presentation, body mass index (BMI), site of skull base defect, surgical approach, intracranial pressure, and clinical follow-up. Results: Fifty-six patients underwent repair of spontaneous CSF leaks. Eighty-two percent (46 of 56) were obese (average BMI 36.2 kg/m2). Nine patients had multiple CSF leaks. Fifty-four patients (96%) had associated encephaloceles. Fifty-three CSF leaks (95%) were successfully repaired at first attempt (34 months of follow-up). Intracranial pressures averaged 27 cm H2O. Patients were treated with acetazolamide or, in severe cases, with a ventriculoperitoneal shunt. Conclusions: Spontaneous CSF leaks have the highest recurrence rate of any etiology. With treatment of underlying intracranial hypertension coupled with endoscopic repair, the success rate (95%) approaches that of other etiologies of CSF leaks.
AB - Objective: To report our outcomes with the repair of spontaneous cerebrospinal fluid (CSF) leaks and to demonstrate how management of underlying intracranial hypertension improves outcomes. Study Design: Retrospective review of spontaneous CSF leaks treated at the University of Pennsylvania Health System from 1996 to 2006. Data collected included demographics, nature of presentation, body mass index (BMI), site of skull base defect, surgical approach, intracranial pressure, and clinical follow-up. Results: Fifty-six patients underwent repair of spontaneous CSF leaks. Eighty-two percent (46 of 56) were obese (average BMI 36.2 kg/m2). Nine patients had multiple CSF leaks. Fifty-four patients (96%) had associated encephaloceles. Fifty-three CSF leaks (95%) were successfully repaired at first attempt (34 months of follow-up). Intracranial pressures averaged 27 cm H2O. Patients were treated with acetazolamide or, in severe cases, with a ventriculoperitoneal shunt. Conclusions: Spontaneous CSF leaks have the highest recurrence rate of any etiology. With treatment of underlying intracranial hypertension coupled with endoscopic repair, the success rate (95%) approaches that of other etiologies of CSF leaks.
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U2 - 10.1016/j.otohns.2008.02.010
DO - 10.1016/j.otohns.2008.02.010
M3 - Article
C2 - 18503841
AN - SCOPUS:43949140159
SN - 0194-5998
VL - 138
SP - 715
EP - 720
JO - Otolaryngology - Head and Neck Surgery
JF - Otolaryngology - Head and Neck Surgery
IS - 6
ER -