Abstract
Spontaneous cerebrospinal fluid (CSF) leaks are defined as leaks without identifiable etiology, often presenting as spontaneous rhinorrhea. This is thought to be a variant of idiopathic intracranial hypertension (IIH). Spontaneous CSF leak closure often requires surgery, which has proven to be less successful than their non-spontaneous counterparts. There is growing evidence that active intracranial pressure (ICP) management in the postoperative care can improve success rates. We aim to give an update about the current use of acetazolamide in the postoperative care of spontaneous CSF leak closure.
Highlights
Spontaneous cerebrospinal fluid (CSF) leaks are defined as leaks without identifiable etiology, often presenting as spontaneous rhinorrhea
Acetazolamide is widely accepted as first line treatment in intracranial hypertension (IIH) and is sometimes used postoperatively after endoscopic closure of spontaneous CSF leaks associated with elevated intracranial pressure (ICP)
The current literature suggests an association between IIH and spontaneous CSF leaks, and even proposes spontaneous CSF leaks to be a direct consequence of long-existing elevated CSF pressure in IIH [25,26]
Summary
The current literature suggests an association between IIH and spontaneous CSF leaks, and even proposes spontaneous CSF leaks to be a direct consequence of long-existing elevated CSF pressure in IIH [25,26]. The International Consensus Statement on Endoscopic Skull-Base Surgery (ICAR; ESBS) recommends considering the use of acetazolamide in patients with spontaneous CSF leaks and elevated ICPs [4]. The ICAR;ESBS views these shunts as an option when patients are unable to tolerate medical ICP management, have persisting elevated ICPs or recurrent CSF leaks [4] Another technique often practiced is the use of lumbar drains (LDs) for perioperative control of ICP. We hypothesize that a routinely administration of acetazolamide postoperatively might even prove to be efficient enough in decreasing ICP in a proportion of patients This might increase success rates as well as prevent postoperative signs or symptoms as found in our described cases.
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