The Rising Incidence of Spontaneous Cerebrospinal Fluid Leaks in the United States and the Association with Obesity and Obstructive Sleep Apnea

Nelson, Rick F.; Gantz, Bruce J.; Hansen, Marlan R.

doi:10.1097/mao.0000000000000535

Cited by 115 publications

(170 citation statements)

References 14 publications

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“…Unlike traumatic or iatrogenic leaks, sCSF leaks are highly associated with obesity and idiopathic intracranial hypertension (IIH). The obesity epidemic in the US started in the 1980s and after a 1–2 decade delay, there has been a corresponding rise in the number of patients with sCSF leaks . Spontaneous CSF leaks do not typically self‐resolve, and require surgical repair.…”

Section: Introductionmentioning

confidence: 99%

Surgical repair of spontaneous cerebrospinal fluid (CSF) leaks: A systematic review

Lobo

Baumanis

Nelson

2017

Laryngoscope Investig Oto

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156

211

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ObjectivesTo review the safety and efficacy of surgical management for spontaneous cerebrospinal fluid (CSF) leaks of the anterior and lateral skull base.Data SourcesA systematic review of English articles using MEDLINE.Review MethodsSearch terms included spontaneous, CSF, cerebrospinal fluid, endoscopic, middle fossa, transmastoid, leak, rhinorrhea. Independent extraction of articles by 3 authors.ResultsPatients with spontaneous CSF leaks are often obese (average BMI of 38 kg/m2) and female (72%). Many patients also have obstructive sleep apnea (∼45%) and many have elevated intracranial pressure when measured by lumbar puncture. In addition to thinning of the skull base, radiographic studies also demonstrate cortical bone thinning. Endoscopic surgical repair of anterior skull base leaks and middle cranial fossa (MCF) approach for repair of lateral skull base leaks are safe and effective with an average short‐term failure rate of 9% and 6.5%, respectively. Long‐term failure rates are low. One randomized trial failed to show improved success of anterior leak repairs with the use of a lumbar drain (LD) (95% with vs. 92% without; P = 0.2). In a large retrospective cohort of MCF lateral skull base repairs, perioperative LD use was not necessary in >94% of patients.ConclusionsSpontaneous CSF leaks are associated with female gender, obesity, increased intracranial hypertension, and obstructive sleep apnea. Endoscopic repair of anterior skull base leaks and MCF or transmastoid approaches for lateral skull base leaks have a high success rate of repair. In most cases, intraoperative placement of lumbar drain did not appear to result in improved success rates for either anterior or lateral skull base leaks.Level of Evidence2a, Systematic Review.

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Section: Introductionmentioning

confidence: 99%

Surgical repair of spontaneous cerebrospinal fluid (CSF) leaks: A systematic review

Lobo

Baumanis

Nelson

2017

Laryngoscope Investig Oto

Self Cite

156

211

View full text Add to dashboard Cite

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“…Many of the reports did not correlate the severity of OSA with polysomnography, nor was it offered to patients with OSA symptoms (snoring, excessive daytime sleepiness, and fatigue). [6][7][8]11 The lack of formal polysomnograms in all patients with spontaneous CSF leaks may have underestimated the incidence of OSA.…”

Section: Discussionmentioning

confidence: 98%

Association Between Obstructive Sleep Apnea and Spontaneous Cerebrospinal Fluid Leaks

Bakhsheshian

Hwang

Friedman

2015

JAMA Otolaryngol Head Neck Surg

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“…Nowadays CSF fistulae are said to be of rising incidence and one study has shown that there is a twofold rise in the incidence of CSF rhinorrhoea in United Kingdom from 2002 to 2012 [6] This could be partly due to the increasing awareness among the medical professionals.…”

Section: Discussionmentioning

confidence: 99%

“…[2] According to the American rhinology society the causes for CSF rhinorrhoea can be classified as Traumatic, accidental traumatic or iatrogenic, tumour related and spontaneous. [2] Most of the scholarly articles have defined spontaneous CSF rhinorrhoea as an entity where the cause for the problem is not clear. However recently there are discussions that majority of the people classified as spontaneous CSF rhinorrhoea could be having intracranial hypertension.…”

Section: Introductionmentioning

confidence: 99%

Is endoscopic repair a successful method in the treatment of CSF Rhinorrhoea? a retrospective study

Dissanayake¹,

Dayasena²

2017

Ceylon J Otolaryngology

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BackgroundCSF rhinorrhoea is an important condition that can lead to morbidity and mortality. The endoscopic method has become the gold standard today for the treatment of nasal CSF fistulae. Many authors have shared their experience in endoscopic CSF leak repair but Sri Lankan data are not available. Hence, it is important to retrospectively audit the Sri Lankan practice. The study aimed at analysing the demographic data and success rates of endoscopic CSF leak repair. MethodologyIt is a retrospective study. Clinical records of all the patients who have undergone endoscopic CSF leak repair at the National Hospital of Sri Lanka during the past 7 years were included in the study. Results29 patients were included in the study. Whilst 20(69%) patients were having spontaneous CSF rhinorrhoea 9(31%) patients had a traumatic aetiology. Out of the patients with spontaneous CSF leak repair 16(80%) were females. The overall success rate of the surgery was 93% which was keeping the international published data. ConclusionEndoscopic CSF repair is a method which is globally accepted and has a very low morbidity and mortality.

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The Rising Incidence of Spontaneous Cerebrospinal Fluid Leaks in the United States and the Association with Obesity and Obstructive Sleep Apnea

Abstract: The national rate of craniotomy for spontaneous CSF leak repair is rising. This condition is yet another public health problem related to the rising obesity epidemic. All patients with spontaneous CSF leaks should be evaluated for OSA.

Cited by 115 publications

References 14 publications

Surgical repair of spontaneous cerebrospinal fluid (CSF) leaks: A systematic review

Surgical repair of spontaneous cerebrospinal fluid (CSF) leaks: A systematic review

Association Between Obstructive Sleep Apnea and Spontaneous Cerebrospinal Fluid Leaks

Is endoscopic repair a successful method in the treatment of CSF Rhinorrhoea? a retrospective study

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