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

AbstractBackground:Closure of spontaneous sphenoid sinus cerebrospinal fluid leaks can be challenging because of the relative inaccessibility of the lateral recess and the presence of intracranial hypertension. We present our experience of such cases and highlight factors associated with a successful outcome.Methods:Eleven patients with spontaneous, laboratory confirmed, sphenoid sinus cerebrospinal fluid leaks were included. All patients underwent endoscopic closure by either a three-layer technique or fat obliteration.Results:In all but one patient, the leak was successfully sealed (success rate, 90.9 per cent; mean follow up, 37.1 months). Elevated intracranial pressure was measured in eight patients, two of whom did not exhibit relevant clinical or radiological characteristics. Five patients received diuretics and dietary advice for weight reduction. In one patient with recurrence two weeks after repair, successful revision was performed by additional placement of a ventriculoperitoneal shunt (follow up, 67 months).Conclusion:Long-lasting cerebrospinal fluid fistula sealing in the sphenoid sinus requires stable reconstruction of the defect in three layers or fat obliteration if the anatomy is unfavourable. All patients should be intra- and post-operatively screened for elevated intracranial pressure to identify those who need additional intracranial pressure reduction measures.

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Markedly Elevated Intracranial Pressure Treated With Cranial Vault Expansion, Instead of CSF Shunting, in a Child With Hurler-Scheie Syndrome and Multiple Suture Craniosynostosis

The Cleft Palate-Craniofacial Journal ◽

10.1177/1055665618777906 ◽

2018 ◽

Vol 56 (3) ◽

pp. 395-399

Author(s):

Jessica A. Ching ◽

Jared S. Troy ◽

Ernesto J. Ruas ◽

Joshua M. Beckman ◽

Gerald F. Tuite

Keyword(s):

Cerebrospinal Fluid ◽

Intracranial Pressure ◽

Cranial Vault ◽

Elevated Intracranial Pressure ◽

Treatment Alternative ◽

Unique Case ◽

Shunt Placement ◽

Scheie Syndrome ◽

Csf Shunting ◽

Viable Treatment

Despite a known association of mucopolysaccharidoses (MPS) and craniosynostosis, treatment of elevated intracranial pressure (ICP) in these patients is primarily cerebrospinal fluid (CSF) shunting. We present a unique case of Hurler-Scheie syndrome with multisuture craniosynostosis and elevated ICP, without ventriculomegaly, where elevated ICP was successfully treated with extensive cranial vault expansion and shunt placement was avoided. Patients with MPS should be evaluated for craniosynostosis, and calvarial vault expansion may be considered as a viable treatment alternative to CSF shunting for elevated ICP in select patients.

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Acetazolamide for high intracranial pressure cerebrospinal fluid leaks

International Forum of Allergy & Rhinology ◽

10.1002/alr.21188 ◽

2013 ◽

Vol 3 (9) ◽

pp. 718-721 ◽

Cited By ~ 41

Author(s):

Mohamad R. Chaaban ◽

Elisa Illing ◽

Kristen O. Riley ◽

Bradford A. Woodworth

Keyword(s):

Cerebrospinal Fluid ◽

Intracranial Pressure ◽

Cerebrospinal Fluid Leaks

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Use of cerebrospinal fluid shunt for the management of elevated intracranial pressure in a patient with active AIDS-related cryptococcal meningitis

Diagnostic Microbiology and Infectious Disease ◽

10.1016/s0732-8893(99)00025-5 ◽

1999 ◽

Vol 34 (2) ◽

pp. 111-114 ◽

Cited By ~ 19

Author(s):

Eleftherios Mylonakis ◽

Nathan A Merriman ◽

Josiah D Rich ◽

Timothy P Flanigan ◽

Beverly C Walters ◽

...

Keyword(s):

Cerebrospinal Fluid ◽

Intracranial Pressure ◽

Cryptococcal Meningitis ◽

Cerebrospinal Fluid Shunt ◽

Elevated Intracranial Pressure

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Faculty Opinions recommendation of Acetazolamide for high intracranial pressure cerebrospinal fluid leaks.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.718016978.793489039 ◽

2013 ◽

Author(s):

Erik K Weitzel ◽

Eugen Stancut

Keyword(s):

Cerebrospinal Fluid ◽

Intracranial Pressure ◽

Cerebrospinal Fluid Leaks

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Spontaneous cerebrospinal fluid leaks in the anterior skull base: a surgical challenge

The Journal of Laryngology & Otology ◽

10.1017/s0022215115000584 ◽

2015 ◽

Vol 129 (4) ◽

pp. 358-364 ◽

Cited By ~ 10

Author(s):

G Martínez-Capoccioni ◽

R Serramito-García ◽

B Huertas-Pardo ◽

A García-Allut ◽

C Martín-Martín

Keyword(s):

Cerebrospinal Fluid ◽

Intracranial Pressure ◽

Patient Characteristics ◽

Functional Endoscopic Sinus Surgery ◽

Sinus Surgery ◽

Recurrence Rates ◽

Closure Rate ◽

Cerebrospinal Fluid Leaks ◽

Additional Therapy

AbstractObjective:This retrospective study aimed to evaluate the effective closure rate for spontaneous cerebrospinal fluid leaks with functional endoscopic sinus surgery and identify patient characteristics that may be associated with a need for additional therapy.Method:A retrospective analysis of patients with spontaneous cerebrospinal fluid leaks was performed. Data on the nature of presentation, patient body mass index, defect location and size, intracranial pressure, clinical follow up, and complications were collected.Results:Twenty-five patients had spontaneous cerebrospinal fluid leaks with evidence of idiopathic intracranial hypertension. The most common sites were the cribriform plate, followed by the ethmoid roof and sphenoid lateral pterygoid recess. All patients underwent endonasal endoscopic surgery to repair the defect. Post-operatively, all patients underwent lumbar drainage and acetazolamide therapy.Conclusion:Spontaneous cerebrospinal fluid leaks represent a surgical challenge because of their high recurrence rates. The most important factor for obtaining a successful repair in these patients is reducing their intracranial pressure through nutritional, medical or surgical means.

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