Abstract
Objectives: Documented elevation of intracranial pressures (ICPs) after repair of cerebrospinal fluid (CSF) leaks may require adjunctive treatment to avoid recurrent or multiple skull base defects. We measured CSF pressure after repair of CSF leaks to obtain additional clinical information that may impact long-term treatment.
Methods: Retrospective review of spontaneous CSF leak patients undergoing surgical repair. ICP was measured through lumbar drains during the immediate postoperative period after CSF leak repair.
Results: Eight patients with spontaneous CSF leaks were surgically treated from 2001–2002. All patients had lumbar drains placed intraoperatively as standard protocol for surgical repair of CSF leaks. On postoperative day 2, CSF pressures were measured using a standardized pressure transducer connected to the lumbar drain. ICPs were elevated in 7 of 8 spontaneous patients (mean, 32.5 cm water; range, 15-52 cm; normal, 0-15 cm). Seven patients were given diuretics (acetazolamide or furosemide) that reduced ICP a mean of 10 cm water. Three patients were eventually referred for long-term shunting. All others were placed on oral diuretics. This group consisted exclusively of obese (mean body mass index, 39.2 kg/m2), middle-aged (mean age, 49.9 years) females.
Conclusions: Measurement of ICPs through lumbar drains is a technique that provides important information regarding the pathophysiology of CSF leaks that impacts subsequent medical and surgical treatment. Although the precise cause and mechanism of spontaneous CSF leaks are not fully understood, this study indicates that elevated ICPs play a role and further medical or surgical treatment to correct the intracranial hypertension may be warranted.