Association of Benign Intracranial Hypertension and Spontaneous Encephalocele With Cerebrospinal Fluid Leak

Brainard, Laura; Chen, Douglas A.; Aziz, Khaled; Hillman, Todd A.

doi:10.1097/mao.0b013e318271c312

Cited by 85 publications

(52 citation statements)

References 22 publications

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“…The congenital defect in the bone or dura is thought to be small in origin but with time and associated factors, such as increased CSF pressure or CSF pulsations, the defect enlarges, allowing for herniation of the intracranial contents [6][7][8][9]. Underlying benign intracranial hypertension may also be responsible [10].…”

Section: Discussionmentioning

confidence: 99%

Occult temporal lobe encephalocoele into the transverse sinus

Asadi

Morokoff

Gaillard

2015

Journal of Clinical Neuroscience

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Section: Discussionmentioning

confidence: 99%

Occult temporal lobe encephalocoele into the transverse sinus

Asadi

Morokoff

Gaillard

2015

Journal of Clinical Neuroscience

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“…There are multiple case reports of tegmen dehiscence and cerebrospinal fluid (CSF) leak occurring together with SSCD . Additionally, there is a known association between tegmental dehiscence and spontaneous CSF leaks with idiopathic intracranial hypertension (IIH) . We also know that obesity is independently associated with IIH .…”

Section: Introductionmentioning

confidence: 99%

Semicircular canal dehiscence among idiopathic intracranial hypertension patients

et al. 2017

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“…It has been hypothesized that elevated intracranial pressure may contribute to progression of temporal bone encephaloceles and CSFF, and an increased risk of recurrence following repair. 1,8,22,26 Given the rarity of the studied conditions, few large series exist in the literature, and optimal surgical management remains controversial. 7,14,15,20,21 Treatment options include the transmastoid approach with tegmen repair or tympanomastoid obliteration, subtemporal middle fossa craniotomy, or a combined mastoid-middle fossa approach.…”

mentioning

confidence: 99%

Temporal bone encephalocele and cerebrospinal fluid fistula repair utilizing the middle cranial fossa or combined mastoid–middle cranial fossa approach

Carlson¹,

Copeland

Driscoll

et al. 2013

JNS

116

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Object The goals of this study were to report the clinical presentation, radiographic findings, operative strategy, and outcomes among patients with temporal bone encephaloceles and cerebrospinal fluid fistulas (CSFFs) and to identify clinical variables associated with surgical outcome. Methods A retrospective case series including all patients who underwent a middle fossa craniotomy or combined mastoid–middle cranial fossa repair of encephalocele and/or CSFF between 2000 and 2012 was accrued from 2 tertiary academic referral centers. Results Eighty-nine consecutive surgeries (86 patients, 59.3% women) were included. The mean age at time of surgery was 52.3 years, and the left side was affected in 53.9% of cases. The mean delay between symptom onset and diagnosis was 35.4 months, and the most common presenting symptoms were hearing loss (92.1%) and persistent ipsilateral otorrhea (73.0%). Few reported a history of intracranial infection (6.7%) or seizures (2.2%). Thirteen (14.6%) of 89 cases had a history of major head trauma, 23 (25.8%) were associated with chronic ear disease without prior operation, 17 (19.1%) occurred following tympanomastoidectomy, and 1 (1.1%) developed in a patient with a cerebral aqueduct cyst resulting in obstructive hydrocephalus. The remaining 35 cases (39.3%) were considered spontaneous. Among all patients, the mean body mass index (BMI) was 35.3 kg/m2, and 46.4% exhibited empty sella syndrome. Patients with spontaneous lesions were statistically significantly older (p = 0.007) and were more commonly female (p = 0.048) compared with those with nonspontaneous pathology. Additionally, those with spontaneous lesions had a greater BMI than those with nonspontaneous disease (p = 0.102), although this difference did not achieve statistical significance. Thirty-two surgeries (36.0%) involved a middle fossa craniotomy alone, whereas 57 (64.0%) involved a combined mastoid–middle fossa repair. There were 7 recurrences (7.9%); 2 patients with recurrence developed meningitis. The use of artificial titanium mesh was statistically associated with the development of recurrent CSFF (p = 0.004), postoperative wound infection (p = 0.039), and meningitis (p = 0.014). Also notable, 6 of the 7 cases with recurrence had evidence of intracranial hypertension. When the 11 cases that involved using titanium mesh were excluded, 96.2% of patients whose lesions were reconstructed with an autologous multilayer repair had neither recurrent CSFF nor meningitis at the last follow-up. Conclusions Patients with temporal bone encephalocele and CSFF commonly present with persistent otorrhea and conductive hearing loss mimicking chronic middle ear disease, which likely contributes to a delay in diagnosis. There is a high prevalence of obesity among this patient population, which may play a role in the pathogenesis of primary and recurrent disease. A middle fossa craniotomy or a combined mastoid–middle fossa approach incorporating a multilayer autologous tissue technique is a safe and reliable method of repair that may be particularly useful for large or multifocal defects. Defect reconstruction using artificial titanium mesh should generally be avoided given increased risks of recurrence and postoperative meningitis.

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Association of Benign Intracranial Hypertension and Spontaneous Encephalocele With Cerebrospinal Fluid Leak

Cited by 85 publications

References 22 publications

Occult temporal lobe encephalocoele into the transverse sinus

Occult temporal lobe encephalocoele into the transverse sinus

Semicircular canal dehiscence among idiopathic intracranial hypertension patients

Temporal bone encephalocele and cerebrospinal fluid fistula repair utilizing the middle cranial fossa or combined mastoid–middle cranial fossa approach

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