Reliability of preoperative assessment of cerebrospinal fluid pressure in the management of spontaneous cerebrospinal fluid leaks and encephaloceles. 2011

Vijay R Ramakrishnan, and Jeffrey D Suh, and Alexander G Chiu, and James N Palmer
Department of Otorhinolaryngology-Head and Neck Surgery, University of Pennsylvania, Philadelphia, PA 19104, USA.

BACKGROUND The association of spontaneous cerebrospinal fluid (CSF) leaks with increased intracranial pressure (ICP) is well-documented. Accurate assessment of CSF pressure is paramount to optimal long-term outcomes, as failure of surgical repair or recurrent leaks may be associated with untreated intracranial hypertension. Many surgeons utilize a single opening pressure measured at the onset of the surgical procedure to determine if long-term acetazolamide or shunt placement will be necessary. However, preoperative measurement of CSF pressure may be inaccurate secondary to active drainage. The purpose of this study is to determine the accuracy of preoperative CSF pressure measurement in the setting of active CSF rhinorrhea. METHODS Retrospective review of 65 cases of endoscopic repair of active spontaneous CSF rhinorrhea performed at a tertiary care institution from 2002 to 2009. A total of 16 cases in which reliable preoperative opening pressure and 48-hour to 72-hour postoperative CSF pressures were recorded were included in the analysis. Cases in which measurements were potentially unreliable or in which acetazolamide therapy was used were excluded from analysis. RESULTS The average preoperative measurement was 26 ± 11 cm H20, and the average postoperative measurement was 15 ± 6 cm H20. The average change in CSF pressure from preoperative to postoperative was -10 ± 11 cm H20. Student paired t test was used to confirm statistical difference between the 2 sets of measurements. CONCLUSIONS Our results suggest that a single preoperative measurement of CSF pressure in patients with active CSF rhinorrhea may not be sufficiently reliable to make subsequent long-term clinical decisions.

UI MeSH Term Description Entries
D008297 Male Males
D011182 Postoperative Care The period of care beginning when the patient is removed from surgery and aimed at meeting the patient's psychological and physical needs directly after surgery. (From Dictionary of Health Services Management, 2d ed) Care, Postoperative,Postoperative Procedures,Procedures, Postoperative,Postoperative Procedure,Procedure, Postoperative
D011300 Preoperative Care Care given during the period prior to undergoing surgery when psychological and physical preparations are made according to the special needs of the individual patient. This period spans the time between admission to the hospital to the time the surgery begins. (From Dictionary of Health Services Management, 2d ed) Care, Preoperative,Preoperative Procedure,Preoperative Procedures,Procedure, Preoperative,Procedures, Preoperative
D002559 Cerebrospinal Fluid Rhinorrhea Discharge of cerebrospinal fluid through the nose. Common etiologies include trauma, neoplasms, and prior surgery, although the condition may occur spontaneously. (Otolaryngol Head Neck Surg 1997 Apr;116(4):442-9) Cerebrospinal Rhinorrhea,CSF Rhinorrhea,Cerebrospinal Fluid Rhinorrhea, Post-Traumatic,Cerebrospinal Fluid Rhinorrhea, Spontaneous,Cerebrospinal Fluid Rhinorrhea, Traumatic,Post-Traumatic Cerebrospinal Fluid Rhinorrhea,Post-Traumatic Rhinorrhea, Cerebrospinal Fluid,Rhinorrhea, Cerebrospinal Fluid, Post-Traumatic,Rhinorrhea, Cerebrospinal Fluid, Spontaneous,Rhinorrhea, Cerebrospinal Fluid, Traumatic,Rhinorrhea, Post-Traumatic, Cerebrospinal Fluid,Rhinorrhea, Spontaneous Cerebrospinal Fluid,Rhinorrhea, Traumatic Cerebrospinal Fluid,Spontaneous Cerebrospinal Fluid Rhinorrhea,Spontaneous Rhinorrhea, Cerebrospinal Fluid,Traumatic Cerebrospinal Fluid Rhinorrhea,Traumatic Rhinorrhea, Cerebrospinal Fluid,CSF Rhinorrheas,Cerebrospinal Fluid Rhinorrhea, Post Traumatic,Cerebrospinal Fluid Rhinorrheas,Cerebrospinal Rhinorrheas,Post Traumatic Cerebrospinal Fluid Rhinorrhea,Post Traumatic Rhinorrhea, Cerebrospinal Fluid,Rhinorrhea, CSF,Rhinorrhea, Cerebrospinal,Rhinorrhea, Cerebrospinal Fluid,Rhinorrheas, CSF,Rhinorrheas, Cerebrospinal,Rhinorrheas, Cerebrospinal Fluid
D004677 Encephalocele Brain tissue herniation through a congenital or acquired defect in the skull. The majority of congenital encephaloceles occur in the occipital or frontal regions. Clinical features include a protuberant mass that may be pulsatile. The quantity and location of protruding neural tissue determines the type and degree of neurologic deficit. Visual defects, psychomotor developmental delay, and persistent motor deficits frequently occur. Frontal Encephalocele,Hernia, Cerebral,Occipital Encephalocele,Acquired Encephalocele,Bifid Cranium,Cephalocele,Cerebellar Hernia,Cerebellar Herniation,Cranial Meningoencephalocele,Craniocele,Cranium Bifidum,Encephalocele, Acquired,Encephalocele, Frontal,Encephalocele, Occipital,Encephalocele, Sincipital,Notoencephalocele,Sincipital Encephalocele,Tonsillar Hernia,Tonsillar Herniation,Acquired Encephaloceles,Bifid Craniums,Bifidum, Cranium,Bifidums, Cranium,Cephaloceles,Cerebellar Hernias,Cerebellar Herniations,Cerebral Hernia,Cerebral Hernias,Cranial Meningoencephaloceles,Cranioceles,Cranium Bifidums,Cranium, Bifid,Craniums, Bifid,Encephaloceles,Encephaloceles, Acquired,Encephaloceles, Frontal,Encephaloceles, Occipital,Encephaloceles, Sincipital,Frontal Encephaloceles,Hernia, Cerebellar,Hernia, Tonsillar,Hernias, Cerebellar,Hernias, Cerebral,Hernias, Tonsillar,Herniation, Cerebellar,Herniation, Tonsillar,Herniations, Cerebellar,Herniations, Tonsillar,Meningoencephalocele, Cranial,Meningoencephaloceles, Cranial,Notoencephaloceles,Occipital Encephaloceles,Sincipital Encephaloceles,Tonsillar Hernias,Tonsillar Herniations
D005260 Female Females
D006801 Humans Members of the species Homo sapiens. Homo sapiens,Man (Taxonomy),Human,Man, Modern,Modern Man
D012189 Retrospective Studies Studies used to test etiologic hypotheses in which inferences about an exposure to putative causal factors are derived from data relating to characteristics of persons under study or to events or experiences in their past. The essential feature is that some of the persons under study have the disease or outcome of interest and their characteristics are compared with those of unaffected persons. Retrospective Study,Studies, Retrospective,Study, Retrospective
D015170 Cerebrospinal Fluid Pressure Manometric pressure of the CEREBROSPINAL FLUID as measured by lumbar, cerebroventricular, or cisternal puncture. Within the cranial cavity it is called INTRACRANIAL PRESSURE. Spinal Fluid Pressure,Cerebrospinal Fluid Pressures,Pressure, Cerebrospinal Fluid,Pressures, Cerebrospinal Fluid,Fluid Pressure, Cerebrospinal,Fluid Pressure, Spinal,Fluid Pressures, Cerebrospinal,Fluid Pressures, Spinal,Pressure, Spinal Fluid,Pressures, Spinal Fluid,Spinal Fluid Pressures
D015203 Reproducibility of Results The statistical reproducibility of measurements (often in a clinical context), including the testing of instrumentation or techniques to obtain reproducible results. The concept includes reproducibility of physiological measurements, which may be used to develop rules to assess probability or prognosis, or response to a stimulus; reproducibility of occurrence of a condition; and reproducibility of experimental results. Reliability and Validity,Reliability of Result,Reproducibility Of Result,Reproducibility of Finding,Validity of Result,Validity of Results,Face Validity,Reliability (Epidemiology),Reliability of Results,Reproducibility of Findings,Test-Retest Reliability,Validity (Epidemiology),Finding Reproducibilities,Finding Reproducibility,Of Result, Reproducibility,Of Results, Reproducibility,Reliabilities, Test-Retest,Reliability, Test-Retest,Result Reliabilities,Result Reliability,Result Validities,Result Validity,Result, Reproducibility Of,Results, Reproducibility Of,Test Retest Reliability,Validity and Reliability,Validity, Face

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