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.
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.
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).
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.
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.