The Need for Emphasis on Intracranial Hypertension Management in Spontaneous Skull Base Meningoencephaloceles
Language English Country United States Media print-electronic
Document type Journal Article
PubMed
36716857
DOI
10.1016/j.wneu.2023.01.083
PII: S1878-8750(23)00098-0
Knihovny.cz E-resources
- Keywords
- Cerebrospinal fluid leak, Intracranial hypertension, Meningoencephalocele, Skull base surgery,
- MeSH
- Skull Base diagnostic imaging surgery MeSH
- Encephalocele complications diagnostic imaging surgery MeSH
- Intracranial Hypertension * etiology surgery diagnosis MeSH
- Humans MeSH
- Meningocele * complications diagnostic imaging surgery MeSH
- Retrospective Studies MeSH
- Cerebrospinal Fluid Rhinorrhea * surgery MeSH
- Cerebrospinal Fluid Leak surgery complications MeSH
- Check Tag
- Humans MeSH
- Publication type
- Journal Article MeSH
OBJECTIVE: To provide an analysis of patients with spontaneous skull base meningoencephaloceles (MECs) to determine whether definitive surgical treatment requires management of elevated intracranial pressure (ICP). METHODS: Data of 10 subjects with spontaneous MECs were collected and retrospectively evaluated. Measurement of ICP, prior interventions, treatment with acetazolamide, and characteristics of long-term elevated ICP, among others, were analyzed. Our own indications for cerebrospinal fluid (CSF) diversion and use of postoperative external lumbar drain were analyzed as well. RESULTS: The sphenoid region was the most common location of MECs. CSF leak was diagnosed in all subjects. The most common graphical signs of elevated ICP were empty sella and arachnoid pits, both of which were present in 90% of cases. Lumbar puncture with opening pressure measurement was performed in 7 patients. Ventriculoperitoneal shunt insertion was indicated in 4 cases before skull base repair and in 2 cases after skull base repair. Two postoperative CSF leaks were managed with external lumbar drain and subsequent shunt installation. CONCLUSIONS: Spontaneous MECs are often associated with CSF leak. ICP assessment should be a standard of care to ensure successful operative repair of MECs. Insertion of a CSF diversion device must be considered where direct or indirect signs of intracranial hypertension are present.
References provided by Crossref.org
