Spontaneous cerebrospinal fluid leak in idiopathic intracranial hypertension [Neurosurgery Wiki]

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=====Spontaneous cerebrospinal fluid leak in idiopathic intracranial hypertension=====

[[Idiopathic intracranial hypertension]] (IIH) is increasingly recognized as a cause of [[spontaneous cerebrospinal fluid leak]] in the otolarnygological and neurosurgical literature. The diagnosis of IIH in patients with spontaneous CSF leaks typically is made a few weeks after surgical repair of the leak when symptoms and signs of elevated intracranial pressure (ICP) appear.

In most cases, they occur in the ethmoid region and the sphenoid bone which is much less affected. Regardless of their etiology, the clinical manifestation of skull base fistulas is usually the same and includes a [[rhinorrhea]] and less frequently an [[otorrhea]]
((Ntsambi-Eba G, Fomekong E, Raftopoulos C. Spontaneous submucosal sphenoidal
fistula discovered intraoperatively. A case report. Neurochirurgie. 2014
Oct;60(5):262-4. doi: 10.1016/j.neuchi.2014.02.009. Epub 2014 May 22. PubMed
PMID: 24856048.
)).

CSF leak occasionally may keep IIH patients symptom-free; however, classic symptoms and signs of intracranial hypertension may develop after a CSF leak is repaired, exposing these patients to a high risk of recurrence of the leak unless an ICP-lowering intervention is performed
((Pérez MA, Bialer OY, Bruce BB, Newman NJ, Biousse V. Primary spontaneous
cerebrospinal fluid leaks and idiopathic intracranial hypertension. J
Neuroophthalmol. 2013 Dec;33(4):330-7. doi: 10.1097/WNO.0b013e318299c292. Review.
PubMed PMID: 24042170; PubMed Central PMCID: PMC4040082.
)).

Evaluation and intervention for elevated ICP in spontaneous CSF leaks is associated with significantly improved success rates following primary endoscopic repair
((Teachey W, Grayson J, Cho DY, Riley KO, Woodworth BA. Intervention for
elevated intracranial pressure improves success rate after repair of spontaneous 
cerebrospinal fluid leaks. Laryngoscope. 2017 May 16. doi: 10.1002/lary.26612.
[Epub ahead of print] PubMed PMID: 28512741.
)).