Multiple spontaneous skull base cerebrospinal fluid leaks: some insights from an international retrospective collaborati
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RHINOLOGY
Multiple spontaneous skull base cerebrospinal fluid leaks: some insights from an international retrospective collaborative study Iacopo Dallan1 · Christina Cambi1 · Enzo Emanuelli2 · Diego Cazzador2 · Frank Rikki Canevari3 · Daniele Borsetto4 · James R. Tysome4 · Neil P. Donnelly4 · Mario Rigante5 · Christos Georgalas6 · Isam Alobid7 · Gabriele Molteni8 · Daniele Marchioni8 · Ahmed Khuram Shahzada9 · Mariella Scarano1 · Veronica Seccia1 · Ernesto Pasquini10 Received: 15 May 2020 / Accepted: 17 July 2020 © Springer-Verlag GmbH Germany, part of Springer Nature 2020
Abstract Purpose Spontaneous skull base cerebrospinal fluid leaks occurring without any apparent cause are rare. But those patients that present such leaks simultaneously, or successively, in multiple locations are even rarer. Given the rarity of this condition, we collected data from other groups in a multicentre study to reach an adequate number of patients and draw some preliminary considerations. Methods We carried out a multicentre retrospective study on a cohort of patients treated at third level hospitals in Italy, Spain, United Kingdom and Greece for multiple spontaneous-CSF leaks and we compared them with a control group of patients treated for recurrent spontaneous-CSF leaks. Data regarding clinical aspects, radiological findings, surgical techniques and outcome were collected and preliminary considerations on the results were discussed. Results A total of 25 patients presented multiple simultaneous spontaneous CSF leaks while 18 patients fit with the criteria of recurrent spontaneous CSF leaks. Data analysis was conducted separately. Conclusions Our understanding of the pathogenesis of this condition is currently very limited. A causative role of IIH may be present but the differences that emerged from the comparison with patients with recurrent fistulas seem to promote the possible role of other cofactors. A longer follow-up period is needed, and, in our opinion, prospective and multicentre studies are the only solution to seriously deal with such a complex topic. Keywords Spontaneous cerebrospinal fluid leak · Skull base · Multiple cerebrospinal fluid leaks · Recurrent cerebrospinal fluid leaks · Idiopathic intracranial hypertension
Introduction The current knowledge on spontaneous cerebrospinal fluid (s-CSF) leaks has increased significantly in recent years and the world around this topic is gradually being understood. * Christina Cambi [email protected] 1
The link between obesity-related conditions and s-CSF leaks is now well established and the role of sleep apnea and increased intracranial hypertension (IIH) is currently accepted [1]. For these reasons the increasing incidence of s-CSF leaks is a logical consequence of the epidemic of 6
Rhinology and Endoscopic Skull Base Unit, Hygeia Hospital, Athens, Greece
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Rhinology and Skull Base Unit, Department of Otorhinolaryngology, Hospital Clínic, Barcelona, Spain
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Otorhinolaryngology‑Head and Neck Surgery, Department of Surgery, University Hospital o
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