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

Published online by Cambridge University Press:  24 April 2015

G Martínez-Capoccioni ,
R Serramito-García ,
B Huertas-Pardo ,
A García-Allut  and
C Martín-Martín
G Martínez-Capoccioni*
Affiliation:
Service of ENT–Head and Neck Surgery, Servizo Galego de Saúde, University Hospital Complex of Santiago de Compostela, Santiago de Compostela, Spain
R Serramito-García
Affiliation:
Service of Neurosurgery, Servizo Galego de Saúde, University Hospital Complex of Santiago de Compostela, Santiago de Compostela, Spain
B Huertas-Pardo
Affiliation:
Service of ENT–Head and Neck Surgery, Servizo Galego de Saúde, University Hospital Complex of Santiago de Compostela, Santiago de Compostela, Spain
A García-Allut
Affiliation:
Service of Neurosurgery, Servizo Galego de Saúde, University Hospital Complex of Santiago de Compostela, Santiago de Compostela, Spain
C Martín-Martín
Affiliation:
Service of ENT–Head and Neck Surgery, Servizo Galego de Saúde, University Hospital Complex of Santiago de Compostela, Santiago de Compostela, Spain
*
Address for correspondence: Dr G Martínez-Capoccioni, Servizo Galego de Saúde, Service of ENT–Head and Neck Surgery, University Hospital Complex of Santiago de Compostela, Santiago de Compostela, Spain E-mail: [email protected]
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Abstract

Objective:

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.

Keywords

Cerebrospinal Fluid LeakCerebrospinal Fluid RhinorrheaEndoscopic Surgical Procedures
Type
Main Articles
Information
The Journal of Laryngology & Otology , Volume 129 , Issue 4 , April 2015 , pp. 358 - 364
Copyright
Copyright © JLO (1984) Limited 2015 

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References

1Hubbard, JL, McDonald, TJ, Pearson, BW, Laws, ER Jr.Spontaneous cerebrospinal fluid rhinorrhea: evolving concepts in diagnosis and surgical management based on the Mayo Clinic experience from 1970 through 1981. Neurosurgery 1985;16:314–21Google Scholar
2Ommaya, AK, Di Chiro, G, Baldwin, M, Pennybacker, JB. Non-traumatic cerebrospinal fluid rhinorrhoea. J Neurol Neurosurg Psychiatry 1968;31:214–25CrossRefGoogle ScholarPubMed
3Lopatin, AS, Kapitanov, DN, Potapov, AA. Endonasal endoscopic repair of spontaneous cerebrospinal fluid leaks. Arch Otolaryngol Head Neck Surg 2003;129:859–63Google Scholar
4Jindal, M, Hiam, L, Raman, A, Rejali, D. Idiopathic intracranial hypertension in otolaryngology. Eur Arch Otorhinolaryngol 2009;266:803–6CrossRefGoogle ScholarPubMed
5Schlosser, RJ, Wilensky, EM, Grady, MS, Bolger, WE. Elevated intracranial pressures in spontaneous cerebrospinal fluid leaks. Am J Rhinol 2003;17:191–5CrossRefGoogle ScholarPubMed
6Woodworth, BA, Prince, A, Chiu, AG, Cohen, NA, Schlosser, RJ, Bolger, WE, Kennedy, DW, Palmer, JN. Spontaneous CSF leaks: a paradigm for definitive repair and management of intracranial hypertension. Otolaryngol Head Neck Surg 2008;138:715–20CrossRefGoogle ScholarPubMed
7Schick, B, Prescher, A, Hofmann, E, Stegerwald, C, Draf, W. Two occult skull base malformations causing recurrent meningitis in a child: a case report. Eur Arch Otorhinolaryngol 2003;260:518–21Google Scholar
8Lai, SY, Kennedy, DW, Bolger, WE. Sphenoid encephaloceles: disease management and identification of lesions within the lateral recess of the sphenoid sinus. Laryngoscope 2002;112:1800–5Google Scholar
9Shetty, PG, Shroff, MM, Fatterpekar, GM, Sahani, DV, Kirtane, MV. A retrospective analysis of spontaneous sphenoid sinus fistula: MR and CT findings. AJNR Am J Neuroradiol 2000;21:337–42Google ScholarPubMed
10Brazis, PW. Clinical review: the surgical treatment of idiopathic pseudotumour cerebri (idiopathic intracranial hypertension). Cephalalgia 2008;28:1361–73Google Scholar
11Schlosser, RJ, Woodworth, BA, Wilensky, EM, Grady, MS, Bolger, WE. Spontaneous cerebrospinal fluid leaks: a variant of benign intracranial hypertension. Ann Otol Rhinol Laryngol 2006;115:495–500Google Scholar
12Friedman, DI, Jacobson, DM. Diagnostic criteria for idiopathic intracranial hypertension. Neurology 2002;59:1492–5Google Scholar
13Schlosser, RJ, Bolger, WE. Spontaneous nasal cerebrospinal fluid leaks and empty sella syndrome: a clinical association. Am J Rhinol 2003;17:91– 6Google Scholar
14Schlosser, RJ, Bolger, WE. Significance of empty sella in cerebrospinal fluid leaks. Otolaryngol Head Neck Surg 2003;128:32–8Google Scholar
15Martín-Martín, C, Martínez-Capoccioni, G, Serramito-García, R, Espinosa-Restrepo, F. Surgical challenge: endoscopic repair of cerebrospinal fluid leak. BMC Res Notes 2012;5:459Google Scholar
16Friedman, DI, Jacobson, DM. Diagnostic criteria for idiopathic intracranial hypertension. Neurology 2002;59:1492–5CrossRefGoogle ScholarPubMed
17Carrau, RL, Snyderman, CH, Kassam, AB. The management of cerebrospinal fluid leaks in patients at risk for high-pressure hydrocephalus. Laryngoscope 2005;115:205–11CrossRefGoogle ScholarPubMed
18Castelnuovo, P, Dallan, I, Pistochini, A, Battaglia, P, Locatelli, D, Bignami, M. Endonasal endoscopic repair of Sternberg's canal cerebrospinal fluid leaks. Laryngoscope 2007;117:345–9Google Scholar
19Schuknecht, B, Simmen, D, Briner, HR, Holzmann, D. Nontraumatic skull base defects with spontaneous CSF rhinorrhea and arachnoid herniation: imaging findings and correlation with endoscopic sinus surgery in 27 patients. AJNR Am J Neuroradiol 2008;29:542–9Google Scholar
20Shetty, PG, Shroff, MM, Fatterpekar, GM, Sahani, DV, Kirtane, MV. A retrospective analysis of spontaneous sphenoid sinus fistula: MR and CT findings. AJNR Am J Neuroradiol 2000;21:337–42Google ScholarPubMed
21Badia, L, Loughran, S, Lund, V. Primary spontaneous cerebrospinal fluid rhinorrea and obesity. Am J Rhinol 2001;15:117–19Google Scholar
22Woodworth, BA, Palmer, JN. Spontaneous cerebrospinal fluid leaks. Curr Opin Otolaryngol Head Neck Surg 2009;17:59–65Google Scholar
23Rossi Izquierdo, M, Martín Martín, C, Labella Caballero, T. Association between cerebrospinal fluid leakage and persistence of Sternberg's canal: coincidence or cause? [in Spanish]. Acta Otorrinolaringol Esp 2012;63:144–6Google Scholar
24Connor, SE. Imaging of skull-base cephalocoeles and cerebrospinal fluid leaks. Clin Radiol 2010;65:832–41CrossRefGoogle ScholarPubMed
25Lloyd, KM, DelGaudio, JM, Hudgins, PA. Imaging of skull base cerebrospinal fluid leaks in adults. Radiology 2008;248:725–36Google Scholar
26Chaaban, MR, Illing, E, Riley, KO, Woodworth, BA. Spontaneous cerebrospinal fluid leak repair: a five-year prospective evaluation. Laryngoscope 2014;124:70–5Google Scholar
27Lopatin, AS, Kapitanov, DN, Potapov, AA. Endonasal endoscopic repair of spontaneous cerebrospinal fluid leaks. Arch Otolaryngol Head Neck Surg 2003;129:859–63Google Scholar
28Bernal-Sprekelsen, M, Bleda-Vázquez, C, Carrau, RL. Ascending meningitis secondary to traumatic CSF leak. Am J Rhinol 2000;14:257–9Google Scholar
29Bernal-Sprekelsen, M, Alobid, I, Mullol, J, Trobat, F, Tomás-Barberán, M. Closure of cerebrospinal fluid leaks prevents ascending bacterial meningitis. Rhinology 2005;43:277–81Google Scholar
30Martínez-Capoccioni, G, Serramito-García, R, Cabanas-Rodríguez, E, García-Allut, A, Martín-Martín, C. Tension pneumocephalus as a result of endonasal surgery: an uncommon intracranial complication. Eur Arch Otorhinolaryngol 2014;271:1043–9Google Scholar
31Zweig, JL, Carrau, RL, Celin, SE, Snyderman, CH, Kassam, A, Hegazy, H. Endoscopic repair of acquired encephaloceles, meningoceles, and meningo-encephaloceles: predictors of success. Skull Base 2002;12:133–9Google Scholar
32Nyquist, GG, Anand, VK, Mehra, S, Kacker, A, Schwartz, TH. Endoscopic endonasal repair of anterior skull base non-traumatic cerebrospinal fluid leaks, meningoceles, and encephaloceles. J Neurosurg 2010;113:961–6Google Scholar
33McCarthy, KD, Reed, DJ. The effect of acetazolamide and furosemide on cerebrospinal fluid production and choroid plexus carbonic anhydrase activity. J Pharmacol Exp Ther 1974;189:194–201Google Scholar
34Anand, VK, Murali, RK, and Glasgold, MJ. Surgical decisions in the management of cerebrospinal fluid rhinorrhoea. Rhinology 1995;33:212–18Google Scholar
35Guido, LJ, and Patterson, RH Jr.Focal neurological deficits secondary to intraoperative CSF drainage: Successful resolution with an epidural blood patch. Report of two cases. J Neurosurg 1976;45:348–51Google Scholar
36Pepper, JP, Lin, EM, Sullivan, SE, and Marentette, LJ. Perioperative lumbar drain placement: An independent predictor of tension pneumocephalus and intracranial complications following anterior skull base surgery. Laryngoscope 2011;121:468–73Google Scholar
37Schlosser, RJ, Wilensky, EM, Grady, MS, Palmer, JN, Kennedy, DW, Bolger, WE. Cerebrospinal fluid pressure monitoring after repair of cerebrospinal fluid leaks. Otolaryngol Head Neck Surg 2004;130:443–8Google Scholar
38Thurtell, MJ, Wall, M. Idiopathic intracranial hypertension (pseudotumor cerebri): recognition, treatment, and ongoing management. Curr Treat Options Neurol 2013;15:1–12Google Scholar
39Sugerman, HJ, Felton, WL 3rd, Salvant, JB Jr, Sismanis, A, Kellum, JM. Effects of surgically induced weight loss on idiopathic intracranial hypertension in morbid obesity. Neurology 1995;45:1655–9Google Scholar
40Sugerman, HJ, Felton, WL 3rd, Sismanis, A, Kellum, JM, DeMaria, EJ, Sugerman, EL. Gastric surgery for pseudotumor cerebri associated with severe obesity. Ann Surg 1999;229:634–40Google Scholar