Skip to main content Accessibility help
×
Home

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

  • G Martínez-Capoccioni (a1), R Serramito-García (a2), B Huertas-Pardo (a1), A García-Allut (a2) and C Martín-Martín (a1)...

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.

Copyright

Corresponding author

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: Gabriel.Adolfo.Martinez.Capoccioni@sergas.es

References

Hide All
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;16:314–21
2Ommaya, AK, Di Chiro, G, Baldwin, M, Pennybacker, JB. Non-traumatic cerebrospinal fluid rhinorrhoea. J Neurol Neurosurg Psychiatry 1968;31:214–25
3Lopatin, AS, Kapitanov, DN, Potapov, AA. Endonasal endoscopic repair of spontaneous cerebrospinal fluid leaks. Arch Otolaryngol Head Neck Surg 2003;129:859–63
4Jindal, M, Hiam, L, Raman, A, Rejali, D. Idiopathic intracranial hypertension in otolaryngology. Eur Arch Otorhinolaryngol 2009;266:803–6
5Schlosser, RJ, Wilensky, EM, Grady, MS, Bolger, WE. Elevated intracranial pressures in spontaneous cerebrospinal fluid leaks. Am J Rhinol 2003;17:191–5
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;138:715–20
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;260:518–21
8Lai, SY, Kennedy, DW, Bolger, WE. Sphenoid encephaloceles: disease management and identification of lesions within the lateral recess of the sphenoid sinus. Laryngoscope 2002;112:1800–5
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;21:337–42
10Brazis, PW. Clinical review: the surgical treatment of idiopathic pseudotumour cerebri (idiopathic intracranial hypertension). Cephalalgia 2008;28:1361–73
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;115:495500
12Friedman, DI, Jacobson, DM. Diagnostic criteria for idiopathic intracranial hypertension. Neurology 2002;59:1492–5
13Schlosser, RJ, Bolger, WE. Spontaneous nasal cerebrospinal fluid leaks and empty sella syndrome: a clinical association. Am J Rhinol 2003;17:91– 6
14Schlosser, RJ, Bolger, WE. Significance of empty sella in cerebrospinal fluid leaks. Otolaryngol Head Neck Surg 2003;128:32–8
15Martín-Martín, C, Martínez-Capoccioni, G, Serramito-García, R, Espinosa-Restrepo, F. Surgical challenge: endoscopic repair of cerebrospinal fluid leak. BMC Res Notes 2012;5:459
16Friedman, DI, Jacobson, DM. Diagnostic criteria for idiopathic intracranial hypertension. Neurology 2002;59:1492–5
17Carrau, RL, Snyderman, CH, Kassam, AB. The management of cerebrospinal fluid leaks in patients at risk for high-pressure hydrocephalus. Laryngoscope 2005;115:205–11
18Castelnuovo, P, Dallan, I, Pistochini, A, Battaglia, P, Locatelli, D, Bignami, M. Endonasal endoscopic repair of Sternberg's canal cerebrospinal fluid leaks. Laryngoscope 2007;117:345–9
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;29:542–9
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;21:337–42
21Badia, L, Loughran, S, Lund, V. Primary spontaneous cerebrospinal fluid rhinorrea and obesity. Am J Rhinol 2001;15:117–19
22Woodworth, BA, Palmer, JN. Spontaneous cerebrospinal fluid leaks. Curr Opin Otolaryngol Head Neck Surg 2009;17:5965
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;63:144–6
24Connor, SE. Imaging of skull-base cephalocoeles and cerebrospinal fluid leaks. Clin Radiol 2010;65:832–41
25Lloyd, KM, DelGaudio, JM, Hudgins, PA. Imaging of skull base cerebrospinal fluid leaks in adults. Radiology 2008;248:725–36
26Chaaban, MR, Illing, E, Riley, KO, Woodworth, BA. Spontaneous cerebrospinal fluid leak repair: a five-year prospective evaluation. Laryngoscope 2014;124:70–5
27Lopatin, AS, Kapitanov, DN, Potapov, AA. Endonasal endoscopic repair of spontaneous cerebrospinal fluid leaks. Arch Otolaryngol Head Neck Surg 2003;129:859–63
28Bernal-Sprekelsen, M, Bleda-Vázquez, C, Carrau, RL. Ascending meningitis secondary to traumatic CSF leak. Am J Rhinol 2000;14:257–9
29Bernal-Sprekelsen, M, Alobid, I, Mullol, J, Trobat, F, Tomás-Barberán, M. Closure of cerebrospinal fluid leaks prevents ascending bacterial meningitis. Rhinology 2005;43:277–81
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;271:1043–9
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;12:133–9
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;113:961–6
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;189:194201
34Anand, VK, Murali, RK, and Glasgold, MJ. Surgical decisions in the management of cerebrospinal fluid rhinorrhoea. Rhinology 1995;33:212–18
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;45:348–51
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;121:468–73
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;130:443–8
38Thurtell, MJ, Wall, M. Idiopathic intracranial hypertension (pseudotumor cerebri): recognition, treatment, and ongoing management. Curr Treat Options Neurol 2013;15:112
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;45:1655–9
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;229:634–40

Keywords

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

  • G Martínez-Capoccioni (a1), R Serramito-García (a2), B Huertas-Pardo (a1), A García-Allut (a2) and C Martín-Martín (a1)...

Metrics

Altmetric attention score

Full text views

Total number of HTML views: 0
Total number of PDF views: 0 *
Loading metrics...

Abstract views

Total abstract views: 0 *
Loading metrics...

* Views captured on Cambridge Core between <date>. This data will be updated every 24 hours.

Usage data cannot currently be displayed