Perioperative continuous cerebrospinal fluid pressure monitoring in patients with spontaneous cerebrospinal fluid leaks

Abstract

Continuous perioperative CSFP monitoring provides valuable insight into multiple physiologic parameters. Systematic continuous CSFP monitoring can identify individuals in need of ICP-lowering therapy, possibly improving the outcomes in CSF leak repair surgeries.

Intervention for elevated intracranial pressure improves success rate after repair of spontaneous cerebrospinal fluid leaks

“…4,5,7,9,11,12 Lumbar puncture has also been used to directly measure opening pressure in numerous studies. [2][3][4][6][7][8][9][13][14][15][16][17][18][19][20] Endoscopic repair is the preferred surgical intervention for spontaneous CSF leaks, but reported success rates vary widely in the literature ranging from 33% to 100%. 9,10,14,16,21,22 Presumably, higher success rates are thought to reflect short-and long-term mitigation of elevated ICP in this patient population, with ventriculoperitoneal shunting, acetazolamide, and other measures such as weight loss.…”

Resumption of Positive-Pressure Ventilation Devices for Obstructive Sleep Apnea following Transsphenoidal Surgery: An Institutional Experience of a Surgical Cohort

“…The other potential complication of OSA that is yet to be considered in this setting is that untreated OSA can lead to elevated intracranial pressure due to retained carbon dioxide, which may predispose patients to a CSF leak. 24,[31][32][33] It is therefore paramount to strike a balance between the risks and benefits of PPV. Currently, no guidelines exist on how to manage PPV after transsphenoidal surgery.…”

Association Between Obstructive Sleep Apnea and Spontaneous Cerebrospinal Fluid Leaks

“…The venous flow is pressure dependent, and the cerebrovascular hemodynamics can be altered by episodes of hypoxia and hypercapnia in patients with OSA, resulting in elevated ICP levels. 3,4 Repetitive ICP elevations during sleep may lead to an overall increase in ICP (Figure 4). Intracranial hypertension could also occur owing to the presence of other risk factors for OSA, such as obesity.…”

“…Obstructive sleep apnea can cause cerebral vasodilation due to periods of hypercapnia, which results in increased ICP. 3,4 Elevated ICP measurements in patients with OSA can also be found while awake. Elevated levels of ICP over time may eventually lead to spontaneous CSF leaks.…”