Idiopathic Intracranial Hypertension Is Associated with Recurrent CSF Leak and Reoperation for Spontaneous Temporal...

Objective  Spontaneous temporal encephaloceles (STEs) are increasingly recognized as sequelae of idiopathic intracranial hypertension (IIH), which in turn may further complicate their management. We endeavored to review the University of Pennsylvania institutional experience on operative management of STEs, with a focus on factors which may influence surgical outcomes, particularly IIH. Design  Retrospective chart review over 9 years from 2013 to 2022. Setting  Single-center, two-hospital, tertiary care, academic setting. Participants  Patients undergoing middle cranial fossa (43.9%), transmastoid (44.9%), or combined (11.2%) approaches for repair of STEs during the study period ( n  = 107). Main Outcome Measures  Postoperative complication rates, recurrence, and diagnosis of IIH. Results  The majority of patients were female (64.5%), with a mean body mass index (BMI) of 37 kg/m ² and mean age of 57 years. Twelve patients (9%) represented reoperations after failed primary repairs. Fourteen percent of patients undergoing primary surgical repair of STE were diagnosed with IIH, compared with 42% of patients undergoing reoperations ( p  = 0.015). In addition, there was a significant difference in the average BMI of patients undergoing primary (36.4 kg/m ² ) versus revision surgery (40.9 kg/m ² , p  = 0.04). Half of those undergoing reoperation were placed on postoperative acetazolamide compared with 11% of patients undergoing primary operations. No patient experienced recurrent leak after reoperation. Conclusion  Based on our institutional experience, elevated BMI and the presence of IIH are significant predictors of reoperation for STE. In our experience, acetazolamide is a common adjunct management strategy in addition to reoperation for patients with recurrent cerebrospinal fluid leak in the setting of STE.