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Abstract：
UNASSIGNED: Increased intracranial pressure is a potential cause of spontaneous cerebrospinal fluid (sCSF) leak. Associated neuro-ophthalmic features have not been well studied, particularly relationships with idiopathic intracranial hypertension (IIH). We hypothesized that neuro-ophthalmic features routinely used in evaluations for IIH can be useful in the investigation of a causal relationship between IIH and sCSF leak. We reviewed the neuro-ophthalmic examination and office-based ophthalmic imaging data of all consecutive patients with sCSF leaks and at least one repair to investigate the clinical and neuro-ophthalmic features of increased intracranial pressure.
UNASSIGNED: We conducted a retrospective longitudinal study at a single institution by querying the electronic medical record system for CSF leak Current Procedural Terminology (CPT) codes (G96.00 and G96.01) from June 1, 2019, to July 31, 2022. For patients with a confirmed diagnosis of sCSF leak, demographic information, eye examination results, and ophthalmic imaging details for both eyes were collected.
UNASSIGNED: A total of 189 patients with CSF leaks were identified through CPT coding; 159 had iatrogenic or traumatic CSF leaks, and 30 individuals (3 male, 27 female) had confirmed sCSF leaks. The mean age of patients with sCSF leaks was 46 years (range: 29 - 81), with a mean body mass index of 35.2 kg/m2 (range: 18.2 - 54.1). Only 11 of 30 underwent eye examinations (8 before surgical repair and 10 after). The mean pre-repair and post-repair best-corrected visual acuity were 20/30 (range: 20/20 - 20/55) and 20/25 (range: 20/20 - 20/40), respectively (P = 0.188). The mean retinal nerve fiber layer thickness was 99 µm (range: 96 - 104) pre-repair and 97 µm (range: 84 - 103) post-repair (P = 0.195). The mean ganglion cell complex thickness was 84 µm (range: 72 - 94) pre-repair and 82 µm (range: 71 - 94) post-repair (P = 0.500). Humphrey visual field average mean deviation was -5.1 (range: -12.4 - -1.8) pre-repair and -1.0 (range: -10.1 - 2.1) post-repair (P = 0.063).
UNASSIGNED: Serial neuro-ophthalmic examinations are recommended for patients with sCSF leaks to screen for signs of current or prior increased intracranial pressure. Larger studies are required to clarify the longitudinal changes in neuro-ophthalmic features, to investigate the incidence of IIH in cases of sCSF leak development or recurrence after surgical repair, and to explore potential causal relationships to guide post-repair management and prevent recurrent leaks. A multicenter consortium is also suggested to develop a standard clinical protocol for comprehensive management of sCSF leaks.
UNASSIGNED: We conducted a retrospective longitudinal study at a single institution by querying the electronic medical record system for CSF leak Current Procedural Terminology (CPT) codes (G96.00 and G96.01) from June 1, 2019, to July 31, 2022. For patients with a confirmed diagnosis of sCSF leak, demographic information, eye examination results, and ophthalmic imaging details for both eyes were collected.
UNASSIGNED: A total of 189 patients with CSF leaks were identified through CPT coding; 159 had iatrogenic or traumatic CSF leaks, and 30 individuals (3 male, 27 female) had confirmed sCSF leaks. The mean age of patients with sCSF leaks was 46 years (range: 29 - 81), with a mean body mass index of 35.2 kg/m2 (range: 18.2 - 54.1). Only 11 of 30 underwent eye examinations (8 before surgical repair and 10 after). The mean pre-repair and post-repair best-corrected visual acuity were 20/30 (range: 20/20 - 20/55) and 20/25 (range: 20/20 - 20/40), respectively (P = 0.188). The mean retinal nerve fiber layer thickness was 99 µm (range: 96 - 104) pre-repair and 97 µm (range: 84 - 103) post-repair (P = 0.195). The mean ganglion cell complex thickness was 84 µm (range: 72 - 94) pre-repair and 82 µm (range: 71 - 94) post-repair (P = 0.500). Humphrey visual field average mean deviation was -5.1 (range: -12.4 - -1.8) pre-repair and -1.0 (range: -10.1 - 2.1) post-repair (P = 0.063).
UNASSIGNED: Serial neuro-ophthalmic examinations are recommended for patients with sCSF leaks to screen for signs of current or prior increased intracranial pressure. Larger studies are required to clarify the longitudinal changes in neuro-ophthalmic features, to investigate the incidence of IIH in cases of sCSF leak development or recurrence after surgical repair, and to explore potential causal relationships to guide post-repair management and prevent recurrent leaks. A multicenter consortium is also suggested to develop a standard clinical protocol for comprehensive management of sCSF leaks.
摘要：
■颅内压升高是自发性脑脊液（sCSF）渗漏的潜在原因。相关的神经眼科特征尚未得到很好的研究，特别是与特发性颅内高压（IIH）的关系。我们假设，常规用于IIH评估的神经眼科特征可用于研究IIH与sCSF泄漏之间的因果关系。我们回顾了所有连续sCSF泄漏和至少一次修复的患者的神经眼科检查和基于办公室的眼科影像学数据，以研究颅内压升高的临床和神经眼科特征。
■从2019年6月1日至2022年7月31日，我们通过查询电子病历系统的CSF泄漏当前程序术语（CPT）代码（G96.00和G96.01），在单个机构进行了回顾性纵向研究。对于确诊为sCSF泄漏的患者，人口统计信息,眼部检查结果,收集了双眼的眼科成像细节。
■通过CPT编码确定了189例CSF泄漏患者；159例具有医源性或创伤性CSF泄漏，和30个人(3名男性，27名女性）已确认sCSF泄漏。sCSF泄漏患者的平均年龄为46岁（范围：29-81），平均体重指数为35.2kg/m2（范围：18.2-54.1）。30人中只有11人接受了眼科检查（手术修复前8人，手术后10人）。修复前和修复后的平均最佳矫正视力为20/30（范围：20/20-20/55）和20/25（范围：20/20-20/40），分别(P=0.188)。平均视网膜神经纤维层厚度为99µm（范围：96-104）修复前和97µm（范围：84-103）修复后（P=0.195）。修复前的平均神经节细胞复合物厚度为84µm（范围：72-94），修复后为82µm（范围：71-94）（P=0.500）。汉弗莱视野平均平均偏差为修复前-5.1（范围：-12.4--1.8）和修复后-1.0（范围：-10.1-2.1）（P=0.063）。
■对于sCSF泄漏的患者，建议进行连续的神经眼科检查，以筛查当前或先前颅内压升高的迹象。需要更大的研究来阐明神经眼科特征的纵向变化。研究在手术修复后发生sCSF渗漏或复发的病例中IIH的发生率，并探索潜在的因果关系，以指导维修后的管理并防止反复泄漏。还建议多中心联盟制定标准的临床方案，以全面管理sCSF泄漏。
■从2019年6月1日至2022年7月31日，我们通过查询电子病历系统的CSF泄漏当前程序术语（CPT）代码（G96.00和G96.01），在单个机构进行了回顾性纵向研究。对于确诊为sCSF泄漏的患者，人口统计信息,眼部检查结果,收集了双眼的眼科成像细节。
■通过CPT编码确定了189例CSF泄漏患者；159例具有医源性或创伤性CSF泄漏，和30个人(3名男性，27名女性）已确认sCSF泄漏。sCSF泄漏患者的平均年龄为46岁（范围：29-81），平均体重指数为35.2kg/m2（范围：18.2-54.1）。30人中只有11人接受了眼科检查（手术修复前8人，手术后10人）。修复前和修复后的平均最佳矫正视力为20/30（范围：20/20-20/55）和20/25（范围：20/20-20/40），分别(P=0.188)。平均视网膜神经纤维层厚度为99µm（范围：96-104）修复前和97µm（范围：84-103）修复后（P=0.195）。修复前的平均神经节细胞复合物厚度为84µm（范围：72-94），修复后为82µm（范围：71-94）（P=0.500）。汉弗莱视野平均平均偏差为修复前-5.1（范围：-12.4--1.8）和修复后-1.0（范围：-10.1-2.1）（P=0.063）。
■对于sCSF泄漏的患者，建议进行连续的神经眼科检查，以筛查当前或先前颅内压升高的迹象。需要更大的研究来阐明神经眼科特征的纵向变化。研究在手术修复后发生sCSF渗漏或复发的病例中IIH的发生率，并探索潜在的因果关系，以指导维修后的管理并防止反复泄漏。还建议多中心联盟制定标准的临床方案，以全面管理sCSF泄漏。
