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Routine Postoperative Adjunct Treatments Unnecessary for Idiopathic Cerebrospinal Fluid Leaks

by Linda Kossoff •

What is the role of routine adjunct treatments for patients with idiopathic cerebrospinal fluid (CSF) leaks to prevent recurrence after endoscopic repair?

BOTTOM LINE: Routine postoperative adjunct treatments in patients with idiopathic CSF are unnecessary and may expose them to adverse long-term side effects.

BACKGROUND: Although idiopathic CSF leaks are the least common of that condition’s etiologies, they have a higher recurrence incidence. Idiopathic intracranial hypertension (IIH) is a potential risk factor for idiopathic CSF leak recurrence after endoscopic repair, and many institutions support routine use of postoperative intracranial pressure-lowering adjunct treatment.

STUDY DESIGN: Retrospective review.

SETTING: Department of Otolaryngology–Head and Neck Surgery, University of Miami-Miller School of Medicine, Miami, Fla.

SYNOPSIS: Researchers conducted a retrospective review of 33 patients who underwent endoscopic transnasal repair of idiopathic CSF rhinorrhea from July 2010 to July 2017. Of these patients, 89% had a BMI of more than 25 kg/m2. Patients with idiopathic CSF leaks historically have higher recurrence rates than those for whom the condition has other etiologies. This difference has been attributed to the failure to address IIH in these patients, thus justifying the routine use of adjunct treatments such as pressure-lowering medication (acetazolamide or topiramate) or surgery (drains or shunts). In this study, however, the higher recurrence rate for idiopathic CSF leaks reported in previous literature was not borne out: The cohort had a 97% success rate, with just four patients requiring additional measures. Given that previous studies supporting adjunct treatments for patients with idiopathic CSF leaks have been uncontrolled cohort studies, and that such measures carry risks of complications, the authors conclude that such routine postoperative adjunct treatments are unnecessary. Study limitations included differences in surgeons’ experience and technique, and literature bias.

CITATION: Sanghvi S, Sarna B, Alam E, et al. Role of adjunct treatments for idiopathic CSF leaks after endoscopic repair. Laryngoscope. 2021;131:41-47.