Table 1.
Reports in the English literature of CSF leaks associated with symptoms and signs of presumed idiopathic intracranial hypertension
| Case series (reference) | Number of cases | % Women | Mean age (years) | BMI (kg/m2) | CSF OP (cmH2O) | Clinical presentation | Site of leakage (N° of patients) | Treatment | Diagnosis of IIH |
|---|---|---|---|---|---|---|---|---|---|
| Brisman et al 1970* (10) | 1 | 100 | 44 | ? | “Elevated” | Rhinorrhea | Cribiform plate | Surgical (craniotomy + sealing of the cribiform plate with muscle) | Yes |
| Applebaum and Desai 1980 (11) | 1 | 100 | 52 | “Moderately obese” | ? | Rhinorrhea, previous meningitis | Sella turcica | Surgical repair | Maybe |
| Eljamel and Foy 1991 (12) | 2 | ? | ? | ? | “High” | Rhinorrhea | ? | LP shunt in one of the patients, unknown for the other patient | Yes |
| Clark et al 1994 (2) | 4 | 100 | 38 | ? | 32 | Rhinorrhea | Cribiform plate | Surgical repair/Lumbar punctures/Diuretics | Yes |
| Camras et al 1998 (13) | 1 | 100 | 46 | “Obese” | 25 | Rhinorrhea, headaches | Anterior cranial fossa | Bifrontal craniotomy + fascia lata graft | Yes |
| Mokri 2002 (9) | 4 | 100 | 27 | ? | 30.8 | Orthostatic headaches-after repair: elevated ICP related-symptoms | Spinal | Surgical repair | Maybe |
| Owler et al 2003 (14) | 1 | 100 | 38 | ? | ? | Rhinorrhea, visual disturbances, headaches | Anterior cranial fossa | Craniotomy + LP shunt; transverse sinus stenting | Yes |
| Schlosser et al 2003 (4) | 16 | 81 | 49.6 | 35.9 | 26.5 | Rhinorrhea, symptoms of elevated ICP | Lateral sphenoid recess (8), central sphenoid (4), ethmoid roof (4), cribiform (2), supraorbital/posterior frontal recess (2), frontal sinus (2) | Surgical repair | Yes |
| Schlosser and Bolger 2003 (15) | 16 | 81 | 49.6 | 35.9 | 28.3 | Rhinorrhea, symptoms of elevated ICP | Lateral sphenoid recess (8), central sphenoid (4), ethmoid roof (4), cribiform (2), supraorbital/posterior frontal recess (2), frontal sinus (2) | Surgical repair | Yes |
| Mirza et al 2005 (16) | 11 | ? | ? | ? | ? | Rhinorrhea, meningitis | Sinonasal | Surgical repair (+ CSF shunting in 3 patients) | Yes |
| Rudnick 2005 (8) | 1 | 100 | 33 | 48.8 | 26 | Rhinorrhea | Cribiform plate | Gastric bypass (weight loss) | Yes |
| Dunn et al 2005 (17) | 15 | 93 | 50 | “Obese” | ? | ? | Roof of the ethmoid (6), sphenoid (5), cribiform plate (4) | Endoscopic repair | Maybe |
| Schlosser et al 2006 (5) | 16 | 81 | 49.6 | 35.9 | 31.1 | Rhinorrhea, symptoms of elevated ICP | Lateral sphenoid recess (8), central sphenoid (4), ethmoid roof (4), cribiform (2), supraorbital/posterior frontal recess (2), frontal sinus (2) | Surgical repair | Yes |
| Prichard et al 2006 (18) | 8 | 50 | 58 | 34.9 | ? | Hearing loss, meningitis, otorrhea, rhinorrhea | Posterior fossa | Surgical repair; LP shunt (in 1 patient) | Maybe |
| Ransom et al 2006 (19) | 1 | 100 | 53 | ? | “Elevated” | Postural headaches, rhinorrhea | Roof of the ethmoid sinus | Revision of VP shunt | Maybe |
| Suryadevara et al 2007 (6) | 2 | 100 | 47 | “Obese” | 26 | Rhinorrhea, headaches, rhinorrhea, meningitis | Cribiform plate | Surgical repair | Yes |
| Woodworth et al 2008 (20) | 55 | 78 | 61 | 43 patients: >30, only one was <25 | 27 | ? | Lateral sphenoid sinus (23), ethmoid roof (17), cribiform plate (12), central sphenoid (7), frontal sinus (7) | Surgical | Maybe |
| Stangherlin et al 2008 (21) | 1 | 100 | 45 | 48 | ? | Rhinorrhea | Left posterior ehtmoidal cell | Gastric banding (weight loss) | Maybe |
| Seth et al 2010 (22) | 39 | 85 | 57.7 | 38.5 | 24 | ? | Cribiform plate, sphenoid lateral pterygoid recess, ethmoid roof | Surgical repair (+ acetazolamide in 9 patients) (+ CSF shunting in 6 patients) | Maybe |
| Reh et al 2010 (23) | 12 | 92 | ? | 40 | Monitoring: > 25 (at least 4% of the time) | Rhinorrhea, headaches, tinnitus | Sphenoid, ethmoid, cribiform | Endoscopic repair + lumbar drain with continuous CSF pressure monitoring | Maybe |
| Yang et al 2011 (3) | 21 | 86 | 53 | 31.2 | 25.5 | Rhinorrhea | Ethmoid sinus (13), lateral sphenoid sinus (7), frontal sinus (1) | Surgical repair + oral diuretics (in some cases) | Yes |
| Brainard et al 2012 (7) | 9 | 89 | 57 | 41 | 24.5 | Otorrhea | ? | ? | Yes |
*
This study also reports 4 additional women with spontaneous CSF leaks and empty sella, but no diagnosis of IIH.
BMI: body mass index; CSF OP: cerebrospinal opening pressure; LP: lumboperitoneal; IIH: idiopathic intracranial hypertension; VP: ventriculoperitoneal