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J Neurol Surg B Skull Base
DOI: 10.1055/a-2198-8374
Original Article

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

Sabrina M. Heman-Ackah 
1   Department of Neurosurgery, Penn Medicine, Philadelphia, Pennsylvania, United States
,
Daksh Chauhan
2   Perelman School of Medicine, Penn Medicine, Philadelphia, Pennsylvania, United States
,
Alexandra E. Quimby
3   Department of Otorhinolaryngology, Penn Medicine, Philadelphia, Pennsylvania, United States
,
Rachel Blue
4   Department of Neurosurgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, United States
,
Michael J. Ruckenstein
3   Department of Otorhinolaryngology, Penn Medicine, Philadelphia, Pennsylvania, United States
,
Douglas C. Bigelow
3   Department of Otorhinolaryngology, Penn Medicine, Philadelphia, Pennsylvania, United States
,
M. Sean Grady
1   Department of Neurosurgery, Penn Medicine, Philadelphia, Pennsylvania, United States
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Abstract

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/m2 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/m2) versus revision surgery (40.9 kg/m2, 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.

Keywords

spontaneous temporal encephalocele - middle cranial fossa - transmastoid - idiopathic intracranial hypertension - obesity - reoperation - recurrent CSF leak


Publication History

Received: 09 June 2023

Accepted: 18 October 2023

Accepted Manuscript online:
25 October 2023

Article published online:
28 November 2023

© 2023. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

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