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Prediction of Postoperative Risk of Raised Intracranial Pressure After Spontaneous Skull Base Cerebrospinal Fluid Leak Repair. 2021

Bryce Buchowicz, and Benson S Chen, and Samuel Bidot, and Beau B Bruce, and Nancy J Newman, and Amit M Saindane, and Joshua M Levy, and Valérie Biousse, and
Departments of Ophthalmology (BB, BSC, BBB, NJN, VB); Pathology (SB); Epidemiology (BBB); Neurology (BBB, NJN, VB); Neurological Surgery (NJN); Radiology and Imaging Sciences (AMS); and Otolaryngology- Head and Neck Surgery (JML), Emory University School of Medicine, Atlanta, Georgia.

A relationship between idiopathic intracranial hypertension and spontaneous skull base cerebrospinal fluid (CSF) leaks has been proposed, by which CSF leak decreases intracranial pressure (ICP) and masks the symptoms and signs of elevated ICP. These patients are at risk of developing papilledema, symptoms of elevated ICP, or a recurrent CSF leak after CSF leak repair. The objective of this study was to assess whether radiographic signs of raised ICP on preoperative magnetic resonance or computed venography (MRI or CTV) are predictors of postoperative papilledema, recurrence of CSF leak, or need for CSF shunt surgery. We performed a retrospective review of systematically collected demographics, fundus examination, and presurgical brain MRI and magnetic resonance venography/computed tomography venography (MRV/CTV) in patients seen at 1 institution between 2013 and 2019 with spontaneous skull base CSF leak repair. Patients were divided into 2 groups depending on whether they developed papilledema, recurrent CSF leak, or required CSF shunting (Group 1) or not (Group 2). Fifty-seven patients were included, among whom 19 were in Group 1. There was no difference in demographic characteristics or clinical features between patients in Group 1 and Group 2. Controlling for other imaging features, bilateral transverse venous sinus stenosis (TVSS) on preoperative imaging increased the odds of being in Group 1 by 4.2 times (95% confidence interval [CI], 1.04-21.2, P = 0.04), optic nerve tortuosity decreased the odds of being in Group 1 by 8.3 times (95% CI: 1.4-74.6, P = 0.02). Imaging of the intracranial venous system with MRV or CTV is warranted before repair of spontaneous CSF leak, as bilateral TVSS is an independent risk factor for postoperative papilledema, CSF leak recurrence, or need for a CSF shunting procedure.

UI MeSH Term Description Entries
D007427 Intracranial Pressure Pressure within the cranial cavity. It is influenced by brain mass, the circulatory system, CSF dynamics, and skull rigidity. Intracerebral Pressure,Subarachnoid Pressure,Intracerebral Pressures,Intracranial Pressures,Pressure, Intracerebral,Pressure, Intracranial,Pressure, Subarachnoid,Pressures, Intracerebral,Pressures, Intracranial,Pressures, Subarachnoid,Subarachnoid Pressures
D011559 Pseudotumor Cerebri A condition marked by raised intracranial pressure and characterized clinically by HEADACHES; NAUSEA; PAPILLEDEMA, peripheral constriction of the visual fields, transient visual obscurations, and pulsatile TINNITUS. OBESITY is frequently associated with this condition, which primarily affects women between 20 and 44 years of age. Chronic PAPILLEDEMA may lead to optic nerve injury (see OPTIC NERVE DISEASES) and visual loss (see BLINDNESS). Benign Intracranial Hypertension,Idiopathic Intracranial Hypertension,Intracranial Hypertension, Benign,Intracranial Hypertension, Idiopathic,Hypertension, Benign Intracranial,Hypertension, Idiopathic Intracranial
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
D019291 Skull Base The inferior region of the skull consisting of an internal (cerebral), and an external (basilar) surface. Basicranium,Cranial Base,Base of Skull,Basis cranii,Base, Cranial,Base, Skull
D019586 Intracranial Hypertension Increased pressure within the cranial vault. This may result from several conditions, including HYDROCEPHALUS; BRAIN EDEMA; intracranial masses; severe systemic HYPERTENSION; PSEUDOTUMOR CEREBRI; and other disorders. Elevated ICP (Intracranial Pressure),Elevated Intracranial Pressure,ICP (Intracranial Pressure) Elevation,ICP (Intracranial Pressure) Increase,Intracranial Pressure Increase,Hypertension, Intracranial,ICP, Elevated (Intracranial Pressure),Intracranial Pressure, Elevated,Pressure Increase, Intracranial,Pressure, Elevated Intracranial
D065634 Cerebrospinal Fluid Leak Discharge of cerebrospinal fluid through a hole through the skull bone most commonly draining from the nose (CEREBROSPINAL FLUID RHINORRHEA) or the ear (CEREBROSPINAL FLUID OTORRHEA). Cerebrospinal Fluid Drainage,Cerebrospinal Fluid Drainage, Post-Traumatic,Cerebrospinal Fluid Drainage, Spontaneous,Cerebrospinal Fluid Drainage, Traumatic,Cerebrospinal Fluid Leak, Post-Traumatic,Cerebrospinal Fluid Leak, Spontaneous,Cerebrospinal Fluid Leak, Traumatic,Cerebrospinal Fluid Leakage,Cerebrospinal Fluid Leakage, Post-Traumatic,Cerebrospinal Fluid Leakage, Spontaneous,Cerebrospinal Fluid Leakage, Traumatic,Spinal Cerebrospinal Fluid Leak,Spinal Cerebrospinal Fluid Leak, Post-Traumatic,Spinal Cerebrospinal Fluid Leak, Spontaneous,Spinal Cerebrospinal Fluid Leak, Traumatic,Cerebrospinal Fluid Drainage, Post Traumatic,Cerebrospinal Fluid Drainages,Cerebrospinal Fluid Leak, Post Traumatic,Cerebrospinal Fluid Leakage, Post Traumatic,Cerebrospinal Fluid Leakages,Cerebrospinal Fluid Leaks,Drainage, Cerebrospinal Fluid,Drainages, Cerebrospinal Fluid,Fluid Drainage, Cerebrospinal,Fluid Drainages, Cerebrospinal,Fluid Leak, Cerebrospinal,Fluid Leakage, Cerebrospinal,Fluid Leakages, Cerebrospinal,Fluid Leaks, Cerebrospinal,Leak, Cerebrospinal Fluid,Leakage, Cerebrospinal Fluid,Leakages, Cerebrospinal Fluid,Leaks, Cerebrospinal Fluid,Spinal Cerebrospinal Fluid Leak, Post Traumatic

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