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Increased intracranial pressure in spontaneous CSF leak patients is not associated with papilledema.
Otolaryngol Head Neck Surg. 2014 Dec; 151(6):1061-6.OH

Abstract

OBJECTIVE

Spontaneous cerebrospinal fluid (CSF) leaks typically present in patients with undiagnosed idiopathic intracranial hypertension (IIH) secondary to pressure erosion of the skull base. Despite elevated intracranial pressure (ICP) on lumbar puncture or ventriculostomy, patients with spontaneous CSF leaks rarely complain of visual disturbances. The objective of this study is to correlate the presence of preoperative papilledema with opening ICP in patients undergoing endoscopic repair of spontaneous CSF leaks.

STUDY DESIGN

Prospective study.

SETTING

Tertiary hospital.

METHODS

Prospective evaluation of patients with spontaneous CSF leaks was performed over a 1-year period (December 2012 to December 2013). Fundoscopic examination for papilledema was completed preoperatively and CSF pressure measured by lumbar puncture or ventriculostomy intraoperatively. Data regarding demographics, nature of presentation, and body mass index (BMI) were also recorded and compared to a control cohort of IIH patients with papilledema.

RESULTS

Sixteen patients (average age 52) were evaluated. Obesity was present in 94% of individuals (average BMI = 43, range, 27-65). Papilledema was absent preoperatively in all subjects. Opening pressures via lumbar puncture/ventriculostomy were 27.4 ± 7.7 cmH20. Following 6 hours of clamping, measurements significantly increased to 36 ± 9.6 cmH20 (P < .001). IIH controls (average age 33, average BMI = 36, range, 21-52) exhibited average ICP (36.2 ± 11.7) identical to postclamp measurements in the spontaneous CSF leak cohort.

CONCLUSIONS

Subjects with spontaneous CSF leaks had postclamping average ICP identical to controls with IIH and papilledema. Such evidence suggests that a CSF leak in this patient population provides sufficient pressure diversion to avoid the development of papilledema.

Authors+Show Affiliations

Departments of Surgery/Division of Otolaryngology, University of Alabama at Birmingham, Birmingham, Alabama, USA.Department of Opthalmology, University of Alabama at Birmingham, Birmingham, Alabama, USA.Department of Opthalmology, University of Alabama at Birmingham, Birmingham, Alabama, USA.Department of Neurosurgery, University of Alabama at Birmingham, Birmingham, Alabama, USA.Departments of Surgery/Division of Otolaryngology, University of Alabama at Birmingham, Birmingham, Alabama, USA bwoodwo@hotmail.com.

Pub Type(s)

Comparative Study
Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

25248848

Citation

Aaron, Geoffrey, et al. "Increased Intracranial Pressure in Spontaneous CSF Leak Patients Is Not Associated With Papilledema." Otolaryngology--head and Neck Surgery : Official Journal of American Academy of Otolaryngology-Head and Neck Surgery, vol. 151, no. 6, 2014, pp. 1061-6.
Aaron G, Doyle J, Vaphiades MS, et al. Increased intracranial pressure in spontaneous CSF leak patients is not associated with papilledema. Otolaryngol Head Neck Surg. 2014;151(6):1061-6.
Aaron, G., Doyle, J., Vaphiades, M. S., Riley, K. O., & Woodworth, B. A. (2014). Increased intracranial pressure in spontaneous CSF leak patients is not associated with papilledema. Otolaryngology--head and Neck Surgery : Official Journal of American Academy of Otolaryngology-Head and Neck Surgery, 151(6), 1061-6. https://doi.org/10.1177/0194599814551122
Aaron G, et al. Increased Intracranial Pressure in Spontaneous CSF Leak Patients Is Not Associated With Papilledema. Otolaryngol Head Neck Surg. 2014;151(6):1061-6. PubMed PMID: 25248848.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Increased intracranial pressure in spontaneous CSF leak patients is not associated with papilledema. AU - Aaron,Geoffrey, AU - Doyle,Jennifer, AU - Vaphiades,Michael S, AU - Riley,Kristen O, AU - Woodworth,Bradford A, Y1 - 2014/09/23/ PY - 2014/9/25/entrez PY - 2014/9/25/pubmed PY - 2015/2/3/medline KW - CSF leak KW - acetazolamide KW - benign intracranial hypertension KW - cerebrospinal fluid KW - idiopathic intracranial hypertension KW - papilledema KW - pseudotumor cerebri KW - shunt KW - spontaneous CSF leak SP - 1061 EP - 6 JF - Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery JO - Otolaryngol Head Neck Surg VL - 151 IS - 6 N2 - OBJECTIVE: Spontaneous cerebrospinal fluid (CSF) leaks typically present in patients with undiagnosed idiopathic intracranial hypertension (IIH) secondary to pressure erosion of the skull base. Despite elevated intracranial pressure (ICP) on lumbar puncture or ventriculostomy, patients with spontaneous CSF leaks rarely complain of visual disturbances. The objective of this study is to correlate the presence of preoperative papilledema with opening ICP in patients undergoing endoscopic repair of spontaneous CSF leaks. STUDY DESIGN: Prospective study. SETTING: Tertiary hospital. METHODS: Prospective evaluation of patients with spontaneous CSF leaks was performed over a 1-year period (December 2012 to December 2013). Fundoscopic examination for papilledema was completed preoperatively and CSF pressure measured by lumbar puncture or ventriculostomy intraoperatively. Data regarding demographics, nature of presentation, and body mass index (BMI) were also recorded and compared to a control cohort of IIH patients with papilledema. RESULTS: Sixteen patients (average age 52) were evaluated. Obesity was present in 94% of individuals (average BMI = 43, range, 27-65). Papilledema was absent preoperatively in all subjects. Opening pressures via lumbar puncture/ventriculostomy were 27.4 ± 7.7 cmH20. Following 6 hours of clamping, measurements significantly increased to 36 ± 9.6 cmH20 (P < .001). IIH controls (average age 33, average BMI = 36, range, 21-52) exhibited average ICP (36.2 ± 11.7) identical to postclamp measurements in the spontaneous CSF leak cohort. CONCLUSIONS: Subjects with spontaneous CSF leaks had postclamping average ICP identical to controls with IIH and papilledema. Such evidence suggests that a CSF leak in this patient population provides sufficient pressure diversion to avoid the development of papilledema. SN - 1097-6817 UR - https://www.unboundmedicine.com/medline/citation/25248848/Increased_intracranial_pressure_in_spontaneous_CSF_leak_patients_is_not_associated_with_papilledema_ L2 - https://journals.sagepub.com/doi/10.1177/0194599814551122?url_ver=Z39.88-2003&amp;rfr_id=ori:rid:crossref.org&amp;rfr_dat=cr_pub=pubmed DB - PRIME DP - Unbound Medicine ER -