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Role of Adjunct Treatments for Idiopathic CSF Leaks After Endoscopic Repair
Author(s) -
Sanghvi Saurin,
Sarna Brooke,
Alam Elie,
Pasol Joshua,
Levine Corinna,
Casiano Roy R.
Publication year - 2021
Publication title -
the laryngoscope
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.181
H-Index - 148
eISSN - 1531-4995
pISSN - 0023-852X
DOI - 10.1002/lary.28720
Subject(s) - medicine , surgery , cribriform plate , retrospective cohort study , rhinorrhea , cerebrospinal fluid leak , cohort , cerebrospinal fluid
Objective A higher incidence of recurrent cerebrospinal fluid (CSF) leaks has been reported with idiopathic CSF leaks. A growing number of institutions advocate for routine use of intracranial pressure‐lowering adjunct treatments after endoscopic repair. We report our results in a patient cohort in which only symptomatic patients are subjected to further testing and treatment. Study Design Retrospective review. Methods A retrospective review of patients who underwent endoscopic transnasal repair of idiopathic CSF rhinorrhea was performed at the University of Miami, Florida, from July 2010 to July 2017. The database was queried for demographical data, surgical details, radiological findings, and postoperative outcomes. Only patients with greater than a 12‐month follow‐up were included. Results Thirty‐three patients underwent endoscopic repair of an idiopathic CSF leak. Twenty‐six (79%) were females, with an average age of entire study population being 48 years. The average body mass index (BMI) of the cohort was 33 kg/m 2 , with 89% being overweight (BMI > 25 kg/m 2 ). The skull base defect was found to be mainly at the cribriform plate (64%) and sphenoid sinus (30%). Endoscopic repair was performed successfully as a single repair in 32 patients (97%). The average follow‐up was 47 months. Postoperative adjunct medications were used on four patients (12%) with symptomatic idiopathic intracranial hypertension. Conclusion Endoscopic repair of idiopathic CSF leaks was found to have a high rate of success in our study. Postoperatively, only four patients required additional measures to medically reduce symptomatic intracranial hypertension. Routine postoperative adjunct treatments are unnecessary and may expose patients to adverse long‐term side effects. Level of Evidence 4 Laryngoscope , 131:41–47, 2021