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Spontaneous CSF Leaks and Encephaloceles

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Skull Base Reconstruction

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Abstract

Spontaneous cerebrospinal fluid (sCSF) leaks and associated encephaloceles develop in the absence of a preceding trauma, skull base surgery, or congenital defect. It is accepted that sCSF leaks represent a variant of idiopathic intracranial hypertension (IIH) . Radiographic features of this disease process include empty sella syndrome, arachnoid pits, and optic nerve sheath dilation and tortuosity. The current standard of care for sCSF leaks includes endoscopic repair with treatment of underlying IIH. Intracranial pressure is monitored and managed with intraoperative placement of a lumbar drain. Postoperatively, IIH may be controlled with acetazolamide; alternatively, other means of controlling ICP such as ventriculoperitoneal (VP) shunting may be utilized for patients with recurrent leaks and multiple skull base defects or without sufficient response to medical treatment (ICP >30 cmH20 despite acetazolamide). Other options for management, particularly in those patients without a sCSF leak, include bariatric surgery or dural venous sinus stenting (VSS). VSS has not been studied extensively in patients with sCSF leak but demonstrates moderately positive results for IIH without leak.

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Authors and Affiliations

  1. Department of Otolaryngology—Head and Neck Surgery, University of Alabama in Birmingham, Birmingham, AL, USA

    Ashwini Tilak, Jessica W. Grayson & Bradford A. Woodworth

  2. Gregory Fleming James Cystic Fibrosis Research Center, Birmingham, AL, USA

    Bradford A. Woodworth

Authors
  1. Ashwini Tilak
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  2. Jessica W. Grayson
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  3. Bradford A. Woodworth
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Correspondence to Bradford A. Woodworth .

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Editors and Affiliations

  1. Otolaryngology-Head and Neck Surgery and Neurological Surgery, University of California, Irvine, Irvine, CA, USA

    Edward C. Kuan

  2. Otorhinolaryngology-Head and Neck Surgery, Rush University Medical Center, Chicago, IL, USA

    Bobby A. Tajudeen

  3. Otolaryngology-Head and Neck Surgery and Neurological Surgery, University of California, Irvine, Irvine, CA, USA

    Hamid R. Djalilian

  4. Otolaryngology-Head and Neck Surgery and Neurological Surgery, University of California, Irvine, Irvine, CA, USA

    Harrison W. Lin

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Tilak, A., Grayson, J.W., Woodworth, B.A. (2023). Spontaneous CSF Leaks and Encephaloceles. In: Kuan, E.C., Tajudeen, B.A., Djalilian, H.R., Lin, H.W. (eds) Skull Base Reconstruction . Springer, Cham. https://doi.org/10.1007/978-3-031-27937-9_11

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  • DOI: https://doi.org/10.1007/978-3-031-27937-9_11

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