{Reference Type}: Journal Article
{Title}: Multiple skull base defects in the setting of spontaneous cerebrospinal fluid rhinorrhea; a dual institution view.
{Author}: Filip P;Patel EA;Khalife S;Baird AM;Dominy C;Joshi K;Feng R;Munich S;Stosic M;Szewka AJ;Shrivastava R;Govindaraj S;Papagiannopoulos P;Batra PS;Tajudeen BA;
{Journal}: Am J Otolaryngol
{Volume}: 45
{Issue}: 1
{Year}: 2024 Jan-Feb 22
{Factor}: 2.873
{DOI}: 10.1016/j.amjoto.2023.104048
{Abstract}: <B>OBJECTIVE: </B>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.<BR><B>METHODS: </B>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.<BR><B>RESULTS: </B>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).<BR><B>CONCLUSIONS: </B>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.