Surgical repair of spontaneous cerebrospinal fluid (CSF) leaks: A systematic review

Brian C. Lobo, Maraya M. Baumanis, Rick Nelson

Research output: Contribution to journalReview article

19 Citations (Scopus)

Abstract

Objectives: To review the safety and efficacy of surgical management for spontaneous cerebrospinal fluid (CSF) leaks of the anterior and lateral skull base. Data Sources: A systematic review of English articles using MEDLINE. Review Methods: Search terms included spontaneous, CSF, cerebrospinal fluid, endoscopic, middle fossa, transmastoid, leak, rhinorrhea. Independent extraction of articles by 3 authors. Results: Patients with spontaneous CSF leaks are often obese (average BMI of 38 kg/m2) and female (72%). Many patients also have obstructive sleep apnea (∼45%) and many have elevated intracranial pressure when measured by lumbar puncture. In addition to thinning of the skull base, radiographic studies also demonstrate cortical bone thinning. Endoscopic surgical repair of anterior skull base leaks and middle cranial fossa (MCF) approach for repair of lateral skull base leaks are safe and effective with an average short-term failure rate of 9% and 6.5%, respectively. Long-term failure rates are low. One randomized trial failed to show improved success of anterior leak repairs with the use of a lumbar drain (LD) (95% with vs. 92% without; P = 0.2). In a large retrospective cohort of MCF lateral skull base repairs, perioperative LD use was not necessary in >94% of patients. Conclusions: Spontaneous CSF leaks are associated with female gender, obesity, increased intracranial hypertension, and obstructive sleep apnea. Endoscopic repair of anterior skull base leaks and MCF or transmastoid approaches for lateral skull base leaks have a high success rate of repair. In most cases, intraoperative placement of lumbar drain did not appear to result in improved success rates for either anterior or lateral skull base leaks. Level of Evidence: 2a, Systematic Review.

Original languageEnglish (US)
Pages (from-to)215-224
Number of pages10
JournalLaryngoscope investigative otolaryngology
Volume2
Issue number5
DOIs
StatePublished - Oct 1 2017

Fingerprint

Skull Base
Middle Cranial Fossa
Intracranial Hypertension
Obstructive Sleep Apnea
Cerebrospinal Fluid
Spinal Puncture
Cerebrospinal Fluid Leak
Information Storage and Retrieval
MEDLINE
Obesity
Safety

Keywords

  • anterior skull base
  • Cerebrospinal fluid leak
  • CSF leak
  • endoscopic repair
  • lateral skull base
  • MCF repair
  • obstructive sleep apnea
  • review
  • spontaneous

Cite this

Surgical repair of spontaneous cerebrospinal fluid (CSF) leaks : A systematic review. / Lobo, Brian C.; Baumanis, Maraya M.; Nelson, Rick.

In: Laryngoscope investigative otolaryngology, Vol. 2, No. 5, 01.10.2017, p. 215-224.

Research output: Contribution to journalReview article

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abstract = "Objectives: To review the safety and efficacy of surgical management for spontaneous cerebrospinal fluid (CSF) leaks of the anterior and lateral skull base. Data Sources: A systematic review of English articles using MEDLINE. Review Methods: Search terms included spontaneous, CSF, cerebrospinal fluid, endoscopic, middle fossa, transmastoid, leak, rhinorrhea. Independent extraction of articles by 3 authors. Results: Patients with spontaneous CSF leaks are often obese (average BMI of 38 kg/m2) and female (72{\%}). Many patients also have obstructive sleep apnea (∼45{\%}) and many have elevated intracranial pressure when measured by lumbar puncture. In addition to thinning of the skull base, radiographic studies also demonstrate cortical bone thinning. Endoscopic surgical repair of anterior skull base leaks and middle cranial fossa (MCF) approach for repair of lateral skull base leaks are safe and effective with an average short-term failure rate of 9{\%} and 6.5{\%}, respectively. Long-term failure rates are low. One randomized trial failed to show improved success of anterior leak repairs with the use of a lumbar drain (LD) (95{\%} with vs. 92{\%} without; P = 0.2). In a large retrospective cohort of MCF lateral skull base repairs, perioperative LD use was not necessary in >94{\%} of patients. Conclusions: Spontaneous CSF leaks are associated with female gender, obesity, increased intracranial hypertension, and obstructive sleep apnea. Endoscopic repair of anterior skull base leaks and MCF or transmastoid approaches for lateral skull base leaks have a high success rate of repair. In most cases, intraoperative placement of lumbar drain did not appear to result in improved success rates for either anterior or lateral skull base leaks. Level of Evidence: 2a, Systematic Review.",
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