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Related Concept Videos

Increased Intracranial Pressure ll: Pathophysiology01:29

Increased Intracranial Pressure ll: Pathophysiology

Increased intracranial pressure (ICP) refers to a potentially life-threatening rise in pressure inside the skull. This usually happens when there is a major change in the volume of brain tissue, blood, or cerebrospinal fluid (CSF) — the three components inside the skull. According to the Monro-Kellie doctrine, if the volume of one component increases, the volumes of the other components must decrease to maintain normal pressure. If this does not happen, ICP rises.The process often begins with...
Increased Intracranial Pressure l: Introduction01:14

Increased Intracranial Pressure l: Introduction

Intracranial hypertension is a sustained elevation of intracranial pressure (ICP) above 22 mm Hg. In supine adults, normal ICP is ~7–15 mm Hg.The rigid, nonexpandable cranium contains three components—brain tissue, blood, and cerebrospinal fluid (CSF)—that total ~1,700 mL in a typical adult: 1,400 mL brain (~80%), 150 mL blood (~10%), and 150 mL CSF (~10%). According to the Monro–Kellie doctrine, total intracranial volume is effectively fixed. When one component expands, CSF and venous blood...
Cerebral Edema ll: Pathophysiology01:22

Cerebral Edema ll: Pathophysiology

Vasogenic edema is a major form of cerebral edema characterized by abnormal accumulation of fluid in the brain’s extracellular space due to disruption of the blood–brain barrier (BBB). The BBB is a specialized structure composed of endothelial cells connected by tight junctions, supported by astrocytic endfeet and a basement membrane. Under normal conditions, it tightly regulates the movement of ions, proteins, and solutes between the bloodstream and brain parenchyma. When this barrier loses...
Cerebral Edema l: Introduction01:19

Cerebral Edema l: Introduction

Cerebral edema is a pathological increase in brain water content that disrupts intracranial pressure regulation and impairs neurological function. Because the cranial vault is rigid, even modest increases in tissue volume can compromise cerebral perfusion, distort neural structures, and initiate secondary injury. Cerebral edema develops through four principal mechanisms: vasogenic, cytotoxic, interstitial, and ionic.Vasogenic EdemaVasogenic edema arises from disruption of the blood–brain...
Brain Abscess l: Introduction01:26

Brain Abscess l: Introduction

A brain abscess is a focal, intracerebral infection characterized by a localized collection of pus within the brain parenchyma, resulting from microbial invasion and the body’s inflammatory response. It progresses through stages: early and late cerebritis, followed by early and late capsule formation, reflecting tissue destruction, immune response, and eventual encapsulation.Etiology and PathogenesisCausative organisms vary with source and host factors, often involving polymicrobial infections,...
Cerebrospinal Fluid01:21

Cerebrospinal Fluid

Cerebrospinal fluid (CSF) is a colorless liquid that flows around the brain and the spinal cord, playing a vital role in the protection, support, and overall function of the central nervous system (CNS). CSF production, circulation, and absorption are tightly regulated processes essential for the brain and spinal cord to function properly.
CSF Production
CSF is produced mainly in the choroid plexus, a network of capillaries and ependymal cells located within the ventricular system of the brain.

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A Bedside, Single Burr Hole Approach to Multimodality Monitoring in Severe Brain Injury
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Risk Reduction of Recurrent Cerebrospinal Fluid Leaks With Postoperative Intracranial Pressure Management: A

Prishae Wilson1, Madison M Doucette2, Ryan Hossain3

  • 1Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic in Florida, Jacksonville, Florida, USA.

Otolaryngology--Head and Neck Surgery : Official Journal of American Academy of Otolaryngology-Head and Neck Surgery
|May 10, 2026
PubMed
Summary

Postoperative intracranial pressure management does not universally reduce cerebrospinal fluid leak recurrence after skull base surgery. Individualized treatment is recommended, as current evidence does not support routine use of these interventions.

Keywords:
cerebrospinal fluid leaksintracranial pressurepressure–lowering interventionsrecurrencesurgical management

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Area of Science:

  • Neurosurgery
  • Otolaryngology
  • Neurology

Background:

  • Spontaneous cerebrospinal fluid (CSF) leaks from the lateral skull base are a significant clinical challenge.
  • Surgical repair is the primary treatment, but recurrence remains a concern.
  • The role of postoperative intracranial pressure-lowering interventions in preventing recurrence is not well-established.

Purpose of the Study:

  • To systematically evaluate the efficacy of postoperative intracranial pressure-lowering interventions in reducing the recurrence of lateral skull base spontaneous CSF leaks following surgical repair.
  • To compare recurrence rates between patients receiving these interventions and those who do not.

Main Methods:

  • A comprehensive literature search was conducted across major databases (Ovid MEDLINE, Embase, Cochrane CENTRAL, Web of Science, Scopus) up to April 2025.
  • Systematic review and meta-analysis adhering to PRISMA guidelines.
  • Inclusion of adult patients with lateral skull base spontaneous CSF leaks undergoing primary surgical repair with specified postoperative interventions.

Main Results:

  • Thirty-six studies with 687 patients (737 cases) were analyzed.
  • No significant difference in recurrence rates was observed between treated and untreated cohorts (RR 1.16, 95% CI: 0.14-9.76).
  • Pooled recurrence rates were similar for intervention-only (0.10) and control-only (0.09) cases, with no observed heterogeneity.

Conclusions:

  • Current evidence does not support the routine use of postoperative intracranial pressure-lowering therapy for all patients undergoing lateral skull base CSF leak repair.
  • Limited data suggest acetazolamide may be beneficial, while lumbar drainage shows no sustained benefit.
  • Individualized postoperative management and further prospective studies in high-risk patients are warranted.