Multifocal Skull Base Defects With Associated Spontaneous Cerebrospinal Fluid Leaks

Area of Science:

• Neurosurgery
• Cerebrospinal Fluid Dynamics
• Skull Base Surgery

Background:

• Spontaneous cerebrospinal fluid (CSF) leaks are often linked to elevated intracranial pressure, potentially leading to multifocal leaks at the skull base.
• Understanding the characteristics and outcomes of patients with multifocal spontaneous CSF leaks is crucial for effective management.

Purpose of the Study:

• To evaluate the clinical presentation and surgical outcomes of patients with multifocal spontaneous CSF leaks.
• To identify demographic and clinical factors associated with multifocal spontaneous CSF leaks.

Main Methods:

• Retrospective case series conducted at a tertiary referral center.
• Inclusion criteria: patients aged 18+ with spontaneous CSF leak diagnosis.
• Multifocal spontaneous CSF leak defined as leaks from multiple distinct skull base defects.

Main Results:

• Out of 293 spontaneous CSF leak patients, 11 (3.8%) had multifocal leaks.
• Multifocal leak patients were significantly more likely to be morbidly obese (BMI 46.2±9.9), female (100%), and African American (63.6%).
• Overall CSF leak repair success rate was 95%, with 50% experiencing postoperative symptoms of elevated intracranial pressure.

Conclusions:

• Multifocal spontaneous CSF leaks are uncommon, predominantly affecting morbidly obese females of African American ethnicity.
• Surgical repair demonstrates high success rates for multifocal spontaneous CSF leaks.
• Patients with multifocal leaks face a significant risk of postoperative intracranial pressure symptoms, necessitating appropriate counseling.