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Otology/Neurotology

(259) Incidence of Intracranial Hypertension Following Surgical Repair of CSF Leak

Monday, October 2, 2023
2:45 PM – 3:45 PM East Coast USA Time
Has Audio

    Presenting Author(s)

  • Akash M. Bhat, BS

    Medical Student
    Drexel University College of Medicine
    Danville, California, United States

    • Co-Author(s)

  • Chim Mee Yang, DO

    Resident
    Western Reserve Hospital (Summa Western Reserve)
    Stow , Ohio, United States

    • Co-Author(s)

  • SK

    Sarah Kortebein, MD

    allegheny general hospital, USA

    • Senior Author(s)

  • Douglas A. Chen, MD

    Clinical Associate Professor-Department of Otolaryngology, Temple University
    Pittsburgh Ear Associates/Allegheny Health Network
    Wexford, Pennsylvania, United States

  • TH

    Todd Hillman, MD

    Todd Hillman MD
    allegheny general hospital
    Wexford, PA, USA

Disclosure(s):
Chim Mee Yang, DO: No relevant relationships to disclose.
Akash M. Bhat, BS: No relevant relationships to disclose.
Douglas A. Chen, MD: No relevant relationships to disclose.


Introduction: To determine the incidence of intracranial hypertension following surgical repair of cerebrospinal fluid leak using lumbar puncture versus fundoscopic exam.

Methods: Retrospective chart review from a tertiary care hospital. Thirty-four adult patients with spontaneous middle fossa cerebrospinal fluid (CSF) leak between 2008 and 2022. Lumbar puncture (LP) with opening pressure versus funduscopic eye exam after surgical repair of lateral skull base encephalocele. Main outcome were patient age, sex, body mass index, and postoperative intracranial pressure, lumbar puncture opening pressure, and funduscopic eye exam results.

Results: Thirty-four patients underwent surgical repair of a lateral skull base encephalocele with CSF leak and then were evaluated for possible idiopathic intracranial hypertension (IIH) with either fundoscopic eye exam or LP with opening pressure. Of these 14 patients underwent a post operative LP and 20 underwent funduscopic eye exam after surgical encephalocele repair of spontaneous CSF otorrhea. Two underwent both exams. The majority of patients were female (88%). The mean patient age was 59.3 (range, 39-82). All patients were overweight or obese with a mean BMI of 38.5 k/m2 (range, 25.1-53.4 kg/m2). Of the 14 patients with LP, 64% had elevated opening pressure with the mean opening pressure of 24.5 cm H2O (range, 10-40 cm H2O). Out of the 20 patients who underwent funduscopic eye exam, 2 or 10% were found to have papilledema. There were 2 patients with a negative funduscopic eye exam but an elevated opening pressure on LP.

Conclusions: The study shows that intracranial hypertension is prevalent in a large portion of patients who have undergone repair of a spontaneous encephalocele with CSF otorrhea. When comparing LP versus funduscopic eye exam for evaluation for idiopathic intracranial hypertension, funduscopic eye exam is missing a large portion of patients which would likely have elevated opening pressures. This raises the question of how these patients should be evaluated and treated to prevent recurrent CSF leak or other sequelae post operatively.