Abstract：
OBJECTIVE: Idiopathic intracranial hypertension (IIH) is a condition of high cerebrospinal fluid (CSF) pressure that presents with CSF leak. The implications of multiple skull base defects (SBD) and associated synchronous CSF leaks have not been previously explored.
METHODS: A dual institutional case-control study examined multiple SBD\'s and encephaloceles on the risk of CSF leak and postoperative failures post-repair. IIH patients with CSF leaks and IIH controls without leaks were selected retrospectively. Chi square analysis evaluated for statistically significant alterations in probability with CSF leak development.
RESULTS: 192 patients were selected with 108 IIH controls and 84 spontaneous CSF leak cases. Signs and symptoms for IIH controls and CSF leak cases respectively were pulsatile tinnitus (60.2 % and 29.8 %), headaches (96.3 % and 63.1 %), papilledema (74.1 % and 12.5 %), visual field defects (60.8 % and 13 %) (p < 0.001). Encephalocele formation in controls was 3.7 % compared to cases at 91.6 % (p < 0.001). Multiple SBD\'s in controls compared cases was 0.9 % and 46.4 % respectively (p < 0.001). Subgroup analysis of CSF leak cases showed 15 patients with two CSF leak repairs due to a recurrence. 27 (39.1 %) single leak cases had multiple SDB\'s while 12 (80 %) recurrent leaks had multiple SDB\'s (p = 0.004).
CONCLUSIONS: Patients with radiographic evidence of multiple SBD\'s and encephaloceles represent a high-risk population with a propensity for CSF leaks. Secondary SBD\'s are common in patients with spontaneous CSF rhinorrhea and higher in patients with a recurrence.
METHODS: A dual institutional case-control study examined multiple SBD\'s and encephaloceles on the risk of CSF leak and postoperative failures post-repair. IIH patients with CSF leaks and IIH controls without leaks were selected retrospectively. Chi square analysis evaluated for statistically significant alterations in probability with CSF leak development.
RESULTS: 192 patients were selected with 108 IIH controls and 84 spontaneous CSF leak cases. Signs and symptoms for IIH controls and CSF leak cases respectively were pulsatile tinnitus (60.2 % and 29.8 %), headaches (96.3 % and 63.1 %), papilledema (74.1 % and 12.5 %), visual field defects (60.8 % and 13 %) (p < 0.001). Encephalocele formation in controls was 3.7 % compared to cases at 91.6 % (p < 0.001). Multiple SBD\'s in controls compared cases was 0.9 % and 46.4 % respectively (p < 0.001). Subgroup analysis of CSF leak cases showed 15 patients with two CSF leak repairs due to a recurrence. 27 (39.1 %) single leak cases had multiple SDB\'s while 12 (80 %) recurrent leaks had multiple SDB\'s (p = 0.004).
CONCLUSIONS: Patients with radiographic evidence of multiple SBD\'s and encephaloceles represent a high-risk population with a propensity for CSF leaks. Secondary SBD\'s are common in patients with spontaneous CSF rhinorrhea and higher in patients with a recurrence.
摘要：
目的：特发性颅内高压（IIH）是一种高脑脊液（CSF）压力的状况，表现为CSF泄漏。先前尚未研究过多种颅底缺损（SBD）和相关的同步CSF泄漏的含义。
方法：一项双重机构病例对照研究检查了多个SBD和脑囊肿对脑脊液漏和修复后术后失败的风险。回顾性选择有CSF泄漏的IIH患者和无泄漏的IIH对照。卡方分析评估了CSF泄漏发展概率的统计学显着变化。
结果：192例患者入选，其中有108例IIH对照和84例自发性CSF漏。IIH对照组和CSF漏病例的体征和症状分别为搏动性耳鸣（60.2%和29.8%），头痛(96.3%和63.1%)，乳头水肿（74.1%和12.5%），视野缺陷(60.8%和13%)(p<0.001)。对照组的脑膨出形成为3.7％，而病例为91.6％（p<0.001）。对照组病例中的多个SBD分别为0.9%和46.4%(p<0.001)。对CSF泄漏病例的亚组分析显示，15例患者因复发而进行了两次CSF泄漏修复。27例(39.1%)单泄漏病例有多个SDB,12例(80%)复发性泄漏有多个SDB(p=0.004)。
结论：具有多个SBD和脑囊肿的影像学证据的患者是具有CSF渗漏倾向的高危人群。继发性SBD在自发性CSF鼻漏患者中常见，在复发患者中更高。
方法：一项双重机构病例对照研究检查了多个SBD和脑囊肿对脑脊液漏和修复后术后失败的风险。回顾性选择有CSF泄漏的IIH患者和无泄漏的IIH对照。卡方分析评估了CSF泄漏发展概率的统计学显着变化。
结果：192例患者入选，其中有108例IIH对照和84例自发性CSF漏。IIH对照组和CSF漏病例的体征和症状分别为搏动性耳鸣（60.2%和29.8%），头痛(96.3%和63.1%)，乳头水肿（74.1%和12.5%），视野缺陷(60.8%和13%)(p<0.001)。对照组的脑膨出形成为3.7％，而病例为91.6％（p<0.001）。对照组病例中的多个SBD分别为0.9%和46.4%(p<0.001)。对CSF泄漏病例的亚组分析显示，15例患者因复发而进行了两次CSF泄漏修复。27例(39.1%)单泄漏病例有多个SDB,12例(80%)复发性泄漏有多个SDB(p=0.004)。
结论：具有多个SBD和脑囊肿的影像学证据的患者是具有CSF渗漏倾向的高危人群。继发性SBD在自发性CSF鼻漏患者中常见，在复发患者中更高。
