ICP, BMI, surgical repair, and CSF diversion in patients presenting with spontaneous CSF otorrhea

Esther X. Vivas, Andrew McCall, Yael Raz, Juan C. Fernandez-Miranda, Paul Gardner, Barry E. Hirsch

Research output: Contribution to journalArticle

17 Citations (Scopus)

Abstract

OBJECTIVE: To assess intracranial pressure (ICP), body mass index (BMI), surgical repair, and cerebrospinal fluid (CSF) diversion in patients presenting with spontaneous CSF otorrhea. STUDY DESIGN: Retrospective series review. SETTING: Tertiary referral center. PATIENTS: Thirty-two patients were treated surgically from 2004 to 2013 for spontaneous CSF otorrhea by the principal investigators. Patients with a history of chronic ear disease and cholesteatoma, previous mastoid surgery, head trauma, or iatrogenic injury were excluded. Average age was 56 years. Twenty-two patients (69%) were female. INTERVENTION(S): Middle fossa repair, transmastoid repair, lumbar puncture, V-P shunt, L-P shunt, and magnetic resonance imaging. MAIN OUTCOME MEASURE(S): Patients underwent middle fossa or transmastoid repair of tegmen defects. Intracranial pressures were determined with lumbar puncture at time of surgical repair or shortly after surgery. CSF diversion procedures were performed in patients who were found to have elevated ICP, which was not controlled medically, presented with recurrent leak or had ICP of 25 cm or greater of H2O. Preoperative BMI was calculated. RESULTS: Thirty-two patients underwent 37 operations. Average BMI was 35.0 kg/m (median, 34.7; range, 18.7-53.2 kg/m). There were 21 repairs on the left and 16 on the right. The majority underwent a middle fossa craniotomy for repair (27/32). Two patients had bilateral repairs. Three patients (8%) underwent revision surgery, of which, 2 had untreated intracranial hypertension (ICP 24.5 and 24 cm H2O). ICP measurements were available for 29 patients. The mean ICP was 23.4 cm H2O (median, 24; range, 13-36 cm H20). Twenty-two patients (69%) had ICP of 20 cm or greater of H20; of those, 13 had an ICP of 25 cm or greater of H20. Seventeen patients (53%) underwent CSF diversion procedures. CONCLUSION: Our findings of elevated ICP and BMI in patients presenting with spontaneous CSF otorrhea are consistent with previous reports in the literature. The percentage of patients that underwent CSF diversion procedures was high at 53% and represents an aggressive stance in managing elevated ICP in a population that may be at risk for subsequent leaks.

Original languageEnglish (US)
Pages (from-to)344-347
Number of pages4
JournalOtology and Neurotology
Volume35
Issue number2
DOIs
StatePublished - Feb 2014
Externally publishedYes

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Cerebrospinal Fluid Otorrhea
Intracranial Pressure
Cerebrospinal Fluid
Body Mass Index
Intracranial Hypertension
Spinal Puncture
Ear Diseases
Cholesteatoma
Mastoid

Keywords

  • Benign intracranial hypertension
  • Body mass index
  • Cerebrospinal fluid diversion
  • Cerebrospinal fluid leak
  • Cerebrospinal fluid otorrhea
  • Cerebrospinal fluid shunt
  • Encephalocele
  • Idiopathic intracranial hypertension
  • Intracranial pressure
  • Middle fossa craniotomy
  • Spontaneous cerebrospinal fluid otorrhea
  • Tegmen defects
  • Transmastoid repair

ASJC Scopus subject areas

  • Otorhinolaryngology
  • Sensory Systems
  • Clinical Neurology

Cite this

ICP, BMI, surgical repair, and CSF diversion in patients presenting with spontaneous CSF otorrhea. / Vivas, Esther X.; McCall, Andrew; Raz, Yael; Fernandez-Miranda, Juan C.; Gardner, Paul; Hirsch, Barry E.

In: Otology and Neurotology, Vol. 35, No. 2, 02.2014, p. 344-347.

Research output: Contribution to journalArticle

Vivas, Esther X. ; McCall, Andrew ; Raz, Yael ; Fernandez-Miranda, Juan C. ; Gardner, Paul ; Hirsch, Barry E. / ICP, BMI, surgical repair, and CSF diversion in patients presenting with spontaneous CSF otorrhea. In: Otology and Neurotology. 2014 ; Vol. 35, No. 2. pp. 344-347.
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AU - Vivas, Esther X.

AU - McCall, Andrew

AU - Raz, Yael

AU - Fernandez-Miranda, Juan C.

AU - Gardner, Paul

AU - Hirsch, Barry E.

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N2 - OBJECTIVE: To assess intracranial pressure (ICP), body mass index (BMI), surgical repair, and cerebrospinal fluid (CSF) diversion in patients presenting with spontaneous CSF otorrhea. STUDY DESIGN: Retrospective series review. SETTING: Tertiary referral center. PATIENTS: Thirty-two patients were treated surgically from 2004 to 2013 for spontaneous CSF otorrhea by the principal investigators. Patients with a history of chronic ear disease and cholesteatoma, previous mastoid surgery, head trauma, or iatrogenic injury were excluded. Average age was 56 years. Twenty-two patients (69%) were female. INTERVENTION(S): Middle fossa repair, transmastoid repair, lumbar puncture, V-P shunt, L-P shunt, and magnetic resonance imaging. MAIN OUTCOME MEASURE(S): Patients underwent middle fossa or transmastoid repair of tegmen defects. Intracranial pressures were determined with lumbar puncture at time of surgical repair or shortly after surgery. CSF diversion procedures were performed in patients who were found to have elevated ICP, which was not controlled medically, presented with recurrent leak or had ICP of 25 cm or greater of H2O. Preoperative BMI was calculated. RESULTS: Thirty-two patients underwent 37 operations. Average BMI was 35.0 kg/m (median, 34.7; range, 18.7-53.2 kg/m). There were 21 repairs on the left and 16 on the right. The majority underwent a middle fossa craniotomy for repair (27/32). Two patients had bilateral repairs. Three patients (8%) underwent revision surgery, of which, 2 had untreated intracranial hypertension (ICP 24.5 and 24 cm H2O). ICP measurements were available for 29 patients. The mean ICP was 23.4 cm H2O (median, 24; range, 13-36 cm H20). Twenty-two patients (69%) had ICP of 20 cm or greater of H20; of those, 13 had an ICP of 25 cm or greater of H20. Seventeen patients (53%) underwent CSF diversion procedures. CONCLUSION: Our findings of elevated ICP and BMI in patients presenting with spontaneous CSF otorrhea are consistent with previous reports in the literature. The percentage of patients that underwent CSF diversion procedures was high at 53% and represents an aggressive stance in managing elevated ICP in a population that may be at risk for subsequent leaks.

AB - OBJECTIVE: To assess intracranial pressure (ICP), body mass index (BMI), surgical repair, and cerebrospinal fluid (CSF) diversion in patients presenting with spontaneous CSF otorrhea. STUDY DESIGN: Retrospective series review. SETTING: Tertiary referral center. PATIENTS: Thirty-two patients were treated surgically from 2004 to 2013 for spontaneous CSF otorrhea by the principal investigators. Patients with a history of chronic ear disease and cholesteatoma, previous mastoid surgery, head trauma, or iatrogenic injury were excluded. Average age was 56 years. Twenty-two patients (69%) were female. INTERVENTION(S): Middle fossa repair, transmastoid repair, lumbar puncture, V-P shunt, L-P shunt, and magnetic resonance imaging. MAIN OUTCOME MEASURE(S): Patients underwent middle fossa or transmastoid repair of tegmen defects. Intracranial pressures were determined with lumbar puncture at time of surgical repair or shortly after surgery. CSF diversion procedures were performed in patients who were found to have elevated ICP, which was not controlled medically, presented with recurrent leak or had ICP of 25 cm or greater of H2O. Preoperative BMI was calculated. RESULTS: Thirty-two patients underwent 37 operations. Average BMI was 35.0 kg/m (median, 34.7; range, 18.7-53.2 kg/m). There were 21 repairs on the left and 16 on the right. The majority underwent a middle fossa craniotomy for repair (27/32). Two patients had bilateral repairs. Three patients (8%) underwent revision surgery, of which, 2 had untreated intracranial hypertension (ICP 24.5 and 24 cm H2O). ICP measurements were available for 29 patients. The mean ICP was 23.4 cm H2O (median, 24; range, 13-36 cm H20). Twenty-two patients (69%) had ICP of 20 cm or greater of H20; of those, 13 had an ICP of 25 cm or greater of H20. Seventeen patients (53%) underwent CSF diversion procedures. CONCLUSION: Our findings of elevated ICP and BMI in patients presenting with spontaneous CSF otorrhea are consistent with previous reports in the literature. The percentage of patients that underwent CSF diversion procedures was high at 53% and represents an aggressive stance in managing elevated ICP in a population that may be at risk for subsequent leaks.

KW - Benign intracranial hypertension

KW - Body mass index

KW - Cerebrospinal fluid diversion

KW - Cerebrospinal fluid leak

KW - Cerebrospinal fluid otorrhea

KW - Cerebrospinal fluid shunt

KW - Encephalocele

KW - Idiopathic intracranial hypertension

KW - Intracranial pressure

KW - Middle fossa craniotomy

KW - Spontaneous cerebrospinal fluid otorrhea

KW - Tegmen defects

KW - Transmastoid repair

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