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Spontaneous cerebrospinal fluid leaks in the anterior skull base secondary to idiopathic intracranial hypertension

  • Rhinology
  • Published:
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Abstract

Spontaneous cerebrospinal fluid (CSF) leaks represent a clinical entity in which CSF rhinorrhea occurs in the absence of any inciting event. Spontaneous CSF leaks are associated with elevated intracranial pressure (ICP) or have underlying idiopathic intracranial hypertension (IIH). We report a cohort of patients who have undergone nasal endoscopic repair for spontaneous CSF leaks. We review our perioperative complications and the effectiveness of the nasal endoscopic approach to repair spontaneous CSF leaks. Also, we examine the evidence correlating spontaneous CSF leaks and IIH and the role of decreasing ICP in the treatment of nasal spontaneous CSF leaks. A retrospective analysis of patients with nasal spontaneous cerebrospinal fluid leaks was performed. Data on the nature of presentation, patient body mass index, defect location and size, ICP, clinical follow-up, and complications were collected. Thirty-five patients had nasal spontaneous cerebrospinal fluid leaks with evidence of IIH’s symptoms. The most common sites were the cribriform plate, the ethmoid roof, and sphenoid lateral pterygoid recess. All patients underwent endonasal endoscopic surgery to repair the defect. Postoperatively, all patients underwent lumbar drainage and acetazolamide therapy. Nasal 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.

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Acknowledgements

We would like to thank the Service of ENT–Head and Neck Surgery and Service of Neurosurgery, University Hospital Complex of Santiago de Compostela, for their assistance in this study.

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Authors and Affiliations

  1. Servizo Galego de Saúde, Service of ENT-Head and Neck Surgery, University Hospital Complex of Santiago de Compostela (CHUS), Santiago de Compostela, Spain

    Gabriel Martínez-Capoccioni, Maria Martín-Bailón & Carlos Martín-Martín

  2. Servizo Galego de Saúde, Service of Neurosurgery, University Hospital Complex of Santiago de Compostela (CHUS), Santiago de Compostela, Spain

    Ramón Serramito-García & Alfredo García-Allut

Authors
  1. Gabriel Martínez-Capoccioni
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  2. Ramón Serramito-García
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  3. Maria Martín-Bailón
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  4. Alfredo García-Allut
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  5. Carlos Martín-Martín
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Corresponding author

Correspondence to Gabriel Martínez-Capoccioni.

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This study was not funded by any company.

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The authors declare that they have no conflict of interest.

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This article does not contain any studies with human participants or animals performed by any of the authors.

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Informed consent was obtained from all individual participants included in the study.

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Martínez-Capoccioni, G., Serramito-García, R., Martín-Bailón, M. et al. Spontaneous cerebrospinal fluid leaks in the anterior skull base secondary to idiopathic intracranial hypertension. Eur Arch Otorhinolaryngol 274, 2175–2181 (2017). https://doi.org/10.1007/s00405-017-4455-5

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  • DOI: https://doi.org/10.1007/s00405-017-4455-5

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