Title

A Comparative Analysis of Anterior & Lateral Cranial Base CSF Leaks

Authors

Rahul Alapati, Thomas Jefferson UniversityFollow
Glen D. Souza, MD
Prachi Patel, Thomas Jefferson University
Chandala Chitguppi, MD, Thomas Jefferson UniversityFollow
Rashiqah Syed, Thomas Jefferson UniversityFollow
Tawfiq Khoury, MD
Mindy R. Rabinowitz, MD, Thomas Jefferson UniversityFollow
Christopher J. Farrell, MD, Thomas Jefferson UniversityFollow
Elina Toskala, MD, PhD, Thomas Jefferson UniversityFollow
Marc R. Rosen, MD, Thomas Jefferson UniversityFollow
James J. Evans, MD, Thomas Jefferson UniversityFollow
Gurston Nyquist, MD, Thomas Jefferson UniversityFollow

Document Type

Abstract

Publication Date

2-2021

Academic Year

2020-2021

Abstract

Introduction

The optimal strategy for management of Idiopathic Intracranial Hypertension (IIH) in anterior and lateral cranial base meningoencephaloceles remains debated. The purpose of this study is to present a comparison of the surgical management of anterior and lateral cranial base meningoencephalocele and a treatment algorithm for the diagnosis and management of IIH in this patient population.

Methods

Retrospective study of 109 patients who underwent anterior or lateral CSF leak repair at TJU from 2004-2020. Epic & RedCap were utilized to record data. Patient demographics, presenting symptoms, imaging, Beta-2 Transferring testing, surgery, repair, and post-op data were collected. Two-sided Chi-squared tests and Independent t-test were performed via SPSS Statistics 26.

Results

49 anterior cranial base (ACB) and 60 lateral cranial base (LCB) defects were included. Anterior cohort had significantly more women (N=77, 85.7%, p=0.02).

Anterior cohort presented with significantly higher multiple leak sites (24.5% vs 15.0%, p=0.036). Six patients, 3 in each cohort, none of whom received Ventriculoperitoneal shunts (VPS) developed recurrence.

VPS were placed for long-term CSF diversion in 23 ACB cases (46.9%) and 10 LCB cases (16.7%), (p<0.01).

Discussion

ACB cases had a higher incidence of females, multiple site leaks, and more likely to undergo VPS placement. No patients developed recurrence after placement of a VPS. Long-term CSF diversion via VPS, in addition to surgical repair, should be considered in patients with elevated intracranial pressure and other high-risk factors to prevent recurrence of CSF leaks.

Recommended Citation

Alapati, Rahul; Souza, MD, Glen D.; Patel, Prachi; Chitguppi, MD, Chandala; Syed, Rashiqah; Khoury, MD, Tawfiq; Rabinowitz, MD, Mindy R.; Farrell, MD, Christopher J.; Toskala, MD, PhD, Elina; Rosen, MD, Marc R.; Evans, MD, James J.; and Nyquist, MD, Gurston, "A Comparative Analysis of Anterior & Lateral Cranial Base CSF Leaks" (2021). Phase 1. Paper 22.
https://jdc.jefferson.edu/si_ctr_2023_phase1/22

Language

English