Neurosurgical focus · 2026
Clinical features of high intracranial pressure and prevalence of idiopathic intracranial hypertension among patients presenting with spontaneous CSF leaks.
СтатьяПоддержка исследования: вне правительства СШАНазвание и аннотация: Перевод в очереди
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Carper Michael G, Guillot Florian H, Gasquet Nicolas C, Carey Andrew R, Henderson Amanda D
Аннотация
OBJECTIVE: Growing evidence indicates that chronically raised intracranial pressure (ICP) might cause a spontaneous CSF leak. However, data on the prevalence of idiopathic intracranial hypertension (IIH) and associated clinical features of high ICP among patients presenting with spontaneous CSF leaks are limited.
METHODS: The authors performed a retrospective review of patients presenting with spontaneous skull base CSF leaks from 2013 to 2020 at a quaternary care center. Demographic, clinical, and imaging characteristics between groups with versus without IIH were compared using the t-test, chi-square test, or Fisher's exact test. Generalized estimating equations estimated visual acuity differences. The authors performed a sensitivity analysis to evaluate the sensitivity, specificity, and predictive value of one or more radiological findings suggestive of high ICP for the diagnosis of IIH among patients with CSF leaks.
RESULTS: Among 55 patients with CSF leaks with complete data, 34 (62%) met criteria for the diagnosis of definite IIH, with 23 having a known diagnosis of IIH prior to CSF leak diagnosis and an additional 11 meeting criteria after surgical CSF leak repair. Compared with patients without confirmed IIH, these patients were more likely to be female (97% vs 76%, p = 0.03), were younger (mean age 44.4 ± 10.4 vs 56.7 ± 10.7 years, p < 0.0001), and had a higher maximum recorded BMI (mean 40.5 ± 8.9 vs 35.47 ± 5.9, p = 0.03). The presence of 1 or more radiological findings suggestive of high ICP (including empty sella, vertical optic nerve tortuosity, posterior globe flattening, venous sinus stenosis, and low-lying cerebellar tonsils) had a specificity of 0.62 and a positive predictive value (PPV) of 0.75 for diagnostic confirmation of IIH. Specificity and PPV increased to 0.91 and 0.88, respectively, with the presence of 2 or more radiological signs. Both specificity and PPV equaled 1 when 3 or more radiological signs suggestive of high ICP were present.
CONCLUSIONS: Nearly two-thirds of patients with CSF leaks in this study met criteria for definite IIH, although strict reliance on IIH diagnostic criteria in the setting of CSF leaks might underestimate the true prevalence. In the setting of a CSF leak, the presence of even 1 radiological sign of high ICP has a high PPV for IIH diagnosis. In this study, PPV increased to 100% when 3 radiological signs of high ICP were present.
METHODS: The authors performed a retrospective review of patients presenting with spontaneous skull base CSF leaks from 2013 to 2020 at a quaternary care center. Demographic, clinical, and imaging characteristics between groups with versus without IIH were compared using the t-test, chi-square test, or Fisher's exact test. Generalized estimating equations estimated visual acuity differences. The authors performed a sensitivity analysis to evaluate the sensitivity, specificity, and predictive value of one or more radiological findings suggestive of high ICP for the diagnosis of IIH among patients with CSF leaks.
RESULTS: Among 55 patients with CSF leaks with complete data, 34 (62%) met criteria for the diagnosis of definite IIH, with 23 having a known diagnosis of IIH prior to CSF leak diagnosis and an additional 11 meeting criteria after surgical CSF leak repair. Compared with patients without confirmed IIH, these patients were more likely to be female (97% vs 76%, p = 0.03), were younger (mean age 44.4 ± 10.4 vs 56.7 ± 10.7 years, p < 0.0001), and had a higher maximum recorded BMI (mean 40.5 ± 8.9 vs 35.47 ± 5.9, p = 0.03). The presence of 1 or more radiological findings suggestive of high ICP (including empty sella, vertical optic nerve tortuosity, posterior globe flattening, venous sinus stenosis, and low-lying cerebellar tonsils) had a specificity of 0.62 and a positive predictive value (PPV) of 0.75 for diagnostic confirmation of IIH. Specificity and PPV increased to 0.91 and 0.88, respectively, with the presence of 2 or more radiological signs. Both specificity and PPV equaled 1 when 3 or more radiological signs suggestive of high ICP were present.
CONCLUSIONS: Nearly two-thirds of patients with CSF leaks in this study met criteria for definite IIH, although strict reliance on IIH diagnostic criteria in the setting of CSF leaks might underestimate the true prevalence. In the setting of a CSF leak, the presence of even 1 radiological sign of high ICP has a high PPV for IIH diagnosis. In this study, PPV increased to 100% when 3 radiological signs of high ICP were present.