An Expedited Intracranial Pressure Monitoring Protocol Following Spontaneous CSF Leak Repair

Objective Spontaneous cerebrospinal fluid (CSF) leaks represent a unique subset of skull base pathology and require distinctive management. Perioperative evaluation and management of intracranial hypertension are essential in preventing further erosion of the skull base and development of recurrent...

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Published in:	The Laryngoscope Vol. 131; no. 2; pp. E408 - E412
Main Authors:	McCormick, Justin P., Tilak, Ashwini, Lampkin, H. Brooks, Thompson, Harrison M., Miller, Peter L., West, John M., Cho, Do‐Yeon, Riley, Kristen O., Grayson, Jessica W., Woodworth, Bradford A.
Format:	Journal Article
Language:	English
Published:	Hoboken, USA John Wiley & Sons, Inc 01-02-2021 Wiley Subscription Services, Inc
Subjects:	Acetazolamide - administration & dosage Adult Aged Cerebrospinal Fluid Rhinorrhea - etiology Cerebrospinal Fluid Rhinorrhea - surgery Clinical Protocols CSF rhinorrhea, spontaneous CSF leak, skull base surgery, skull base repair, idiopathic intracranial hypertension, CSF leak repair, intracranial hypertension, endoscopic CSF leak repair, lumbar drain, intracranial pressure Diuretics - administration & dosage Endoscopy Endoscopy - adverse effects Female Humans Hypertension Intracranial Hypertension - diagnosis Intracranial Hypertension - etiology Intracranial Hypertension - physiopathology Intracranial Hypertension - therapy Intracranial pressure Intracranial Pressure - physiology Laryngoscopy Length of Stay - statistics & numerical data Male Middle Aged Neurophysiological Monitoring - methods Postoperative Care - methods Postoperative Complications - diagnosis Postoperative Complications - epidemiology Postoperative Complications - etiology Postoperative Complications - therapy Prospective Studies Spinal Puncture Time Factors Treatment Outcome Ventriculoperitoneal Shunt - statistics & numerical data CSF rhinorrhea, spontaneous CSF leak, skull base surgery, skull base repair, idiopathic intracranial hypertension, CSF leak repair, intracranial hypertension, endoscopic CSF leak repair, lumbar drain, intracranial pressure
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Summary:	Objective Spontaneous cerebrospinal fluid (CSF) leaks represent a unique subset of skull base pathology and require distinctive management. Perioperative evaluation and management of intracranial hypertension are essential in preventing further erosion of the skull base and development of recurrent leak. The objective of this study is to evaluate the safety and utility of an expedited protocol for recording and managing intracranial hypertension following endoscopic repair of spontaneous CSF leaks. Methods Prospectively collected data was reviewed in patients undergoing endoscopic repair of spontaneous CSF leaks between January 2017 and March 2020. A standard intracranial pressure monitoring protocol was compared to an expedited protocol (EP), and data regarding the two groups was compared for leak location, short‐term success of skull base repair, complications, hospital length of stay, and cost‐based analysis. Results Fifty‐five patients (standard protocol, n = 28 vs. EP, n = 27) were included in the study. Leak location was similar between cohorts, with the lateral recess being the most common locations in both groups (37.9% vs. 40.6%; P = .90). Postoperative complications (3.6% vs. 7.4%; P = .53) and ventriculoperitoneal shunt rate (32.1% vs. 22.2%; P = .41) were similar among cohorts. There was no difference in lumbar drain complications (0% vs. 7.4%; P = .14) or recurrent leak (7.1% vs. 0%; P = .16). Length of stay was shorter in the EP group [median(interquartile range): 3(1) vs. 2 (1); P < .01]. Total hospital charges were similar between groups (median (USD/$1,000): 83.57 ± 49.58 vs. 83.93 ± 46.11; P = .18). Conclusion An expedited monitoring protocol shortened hospital stay without increased risk of complications. Level of Evidence III Laryngoscope, 131:E408–E412, 2021
Bibliography:	Editor's Note: This Manuscript was accepted for publication on June 19, 2020. These authors contributed equally to this work. The authors have no other funding, financial relationships, or conflicts of interest to disclose. B.A.W. is a consultant for Cook Medical LLC (Bloomington, IN), Smith & Nephew plc, (London, UK) and Baxter International Inc, (Deerfield, IL). J.W.G served as a member of an Advisory Board with Glaxo‐Smith‐Kline. ObjectType-Article-2 SourceType-Scholarly Journals-1 ObjectType-Undefined-1 ObjectType-Feature-3 content type line 23
ISSN:	0023-852X 1531-4995
DOI:	10.1002/lary.28929