Spontaneous Cerebrospinal Fluid Rhinorrhea: Association with Body Weight and Imaging Data

Raphaële Quatre; Arnaud Attye; Christian Adrien Righini; Emile Reyt; Joris Giai; Sébastien Schmerber; Alexandre Karkas

doi:10.1055/s-0037-1603731

Journal of Neurological Surgery Part B: Skull Base, Inhaltsverzeichnis

J Neurol Surg B Skull Base 2017; 78(05): 419-424
DOI: 10.1055/s-0037-1603731

Original Article

Georg Thieme Verlag KG Stuttgart · New York

Spontaneous Cerebrospinal Fluid Rhinorrhea: Association with Body Weight and Imaging Data

Autoren

Raphaële Quatre

¹Joseph Fourier University, UFR Medecine, Grenoble, France

²Department of Otolaryngology-Head and Neck Surgery, Grenoble University Hospital, Grenoble, France
Arnaud Attye

¹Joseph Fourier University, UFR Medecine, Grenoble, France

³Department of Neuroradiology, Grenoble University Hospital, Grenoble, France
Christian Adrien Righini

¹Joseph Fourier University, UFR Medecine, Grenoble, France

²Department of Otolaryngology-Head and Neck Surgery, Grenoble University Hospital, Grenoble, France
Emile Reyt

¹Joseph Fourier University, UFR Medecine, Grenoble, France

²Department of Otolaryngology-Head and Neck Surgery, Grenoble University Hospital, Grenoble, France
Joris Giai

⁴Department of Epidemiology and Public Health, Grenoble University Hospital, Grenoble, France

⁵Department of Biostatistics, Lyon University Hospital, Lyon, France

⁶Claude Bernard University of Lyon 1, UFR Medecine, University of Lyon, Lyon, France
Sébastien Schmerber

¹Joseph Fourier University, UFR Medecine, Grenoble, France

²Department of Otolaryngology-Head and Neck Surgery, Grenoble University Hospital, Grenoble, France
Alexandre Karkas

¹Joseph Fourier University, UFR Medecine, Grenoble, France

²Department of Otolaryngology-Head and Neck Surgery, Grenoble University Hospital, Grenoble, France

⁷Department of Otolaryngology-Head and Neck Surgery, Saint-Etienne University Hospital, Saint-Etienne, France

Abstract

Objective Spontaneous cerebrospinal fluid rhinorrhea (SCSFR) might be the only clinical manifestation of idiopathic intracranial hypertension (IIH), which has been historically related to overweight. Our goal was to search for an association between SCSFR and increased body weight on the one hand and SCSFR and imaging findings suggestive of IIH on the other hand.

Materials and Methods We retrospectively collected clinical and radiological data of patients operated on endoscopically for SCSFR in our institution from 1993 to 2013. Analyzed factors were body mass index (BMI), extended sphenoid sinus pneumatization on computed tomography, and empty sella and distention of the optic nerve sheath on magnetic resonance imaging.

Results There were 15 patients: 8 females/7 males; mean age 50 years. Primary surgical success rate was 86.7%. Regarding body weight, 80% were overweight (BMI ≥ 25) versus 32% in the French general population (p < 0.001). Among patients with SCSFR, 20% were obese (BMI ≥ 30) versus 15% in French individuals without SCSFR (p = 0.483). Increased pneumatization of sphenoid sinuses was observed in 92.9 versus 27.5% in the general population (p < 0.0001). Empty sella was found in 46.2 versus 3% in the general population (p < 0.00001). Dilation of the optic nerve sheath was observed in 46.2 versus 15% in the general population (p < 0.01).

Conclusion We found statistically significant associations between SCSFR and overweight, increased pneumatization of sphenoid sinuses, empty sella, and dilation of optic nerve sheath, but not with obesity, which did not have any additional impact of CSF leak than did overweight.

Keywords

spontaneous cerebrospinal fluid rhinorrhea - intracranial pressure - sphenoid sinus - pneumatization - empty sella - optic nerve sheath

Volltext

Referenzen

References
1 Locatelli D, Rampa F, Acchiardi I, Bignami M, De Bernardi F, Castelnuovo P. Endoscopic endonasal approaches for repair of cerebrospinal fluid leaks: nine-year experience. Neurosurgery 2006; 58 (04) (Suppl. 02) ONS-246-ONS-256 , ONS-256–ONS-257
2 Banks CA, Palmer JN, Chiu AG, O'Malley Jr BW, Woodworth BA, Kennedy DW. Endoscopic closure of CSF rhinorrhea: 193 cases over 21 years. Otolaryngol Head Neck Surg 2009; 140 (06) 826-833
3 Alonso RC, de la Peña MJ, Caicoya AG, Rodriguez MR, Moreno EA, de Vega Fernandez VM. Spontaneous skull base meningoencephaloceles and cerebrospinal fluid fistulas. Radiographics 2013; 33 (02) 553-570
4 Wise SK, Schlosser RJ. Evaluation of spontaneous nasal cerebrospinal fluid leaks. Curr Opin Otolaryngol Head Neck Surg 2007; 15 (01) 28-34
5 Karkas A, Atallah I, Son HJ, Schmerber S. Temporal bone meningocele/encephalocele. In: Kountakis SE. , ed. Encyclopedia of Otolaryngology, Head and Neck Surgery. Berlin, Heidelberg: Springer; 2013: 2724-2736
6 Butros SR, Goncalves LF, Thompson D, Agarwal A, Lee HK. Imaging features of idiopathic intracranial hypertension, including a new finding: widening of the foramen ovale. Acta Radiol 2012; 53 (06) 682-688
7 Son HJ, Karkas A, Buchanan P. , et al. Spontaneous cerebrospinal fluid effusion of the temporal bone: repair, audiological outcomes, and obesity. Laryngoscope 2014; 124 (05) 1204-1208
8 Suzuki H, Takanashi J, Kobayashi K, Nagasawa K, Tashima K, Kohno Y. MR imaging of idiopathic intracranial hypertension. AJNR Am J Neuroradiol 2001; 22 (01) 196-199
9 Shetty PG, Shroff MM, Fatterpekar GM, Sahani DV, Kirtane MV. A retrospective analysis of spontaneous sphenoid sinus fistula: MR and CT findings. AJNR Am J Neuroradiol 2000; 21 (02) 337-342
10 Eschwege E, Charles MA, Basdevant A. , et al. Epidemiological study on French overweight and obesity. Available at: http://www.roche.fr/content/dam/corporate/roche_fr/doc/obepi_2012.pdf . Accessed October 16, 2012
11 Scuderi AJ, Harnsberger HR, Boyer RS. Pneumatization of the paranasal sinuses: normal features of importance to the accurate interpretation of CT scans and MR images. AJR Am J Roentgenol 1993; 160 (05) 1101-1104
12 Sotoudeh H, Bowerson M, Parsons M. , et al. Effect of spatial resolution of T2-weighted imaging on diagnostic efficacy of MRI in detection of papilledema. AJR Am J Roentgenol 2015; 204 (03) 602-607
13 Schlosser RJ, Woodworth BA, Wilensky EM, Grady MS, Bolger WE. Spontaneous cerebrospinal fluid leaks: a variant of benign intracranial hypertension. Ann Otol Rhinol Laryngol 2006; 115 (07) 495-500
14 Gacek RR, Gacek MR, Tart R. Adult spontaneous cerebrospinal fluid otorrhea: diagnosis and management. Am J Otol 1999; 20 (06) 770-776
15 Brainard L, Chen DA, Aziz KM, Hillman TA. Association of benign intracranial hypertension and spontaneous encephalocele with cerebrospinal fluid leak. Otol Neurotol 2012; 33 (09) 1621-1624
16 Woodworth BA, Bolger WE, Schlosser RJ. Nasal cerebrospinal fluid leaks and encephaloceles. Oper Tech Otolaryngol--Head Neck Surg 2006; 17: 111-116 . DOI: http://dx.doi.org/10.1016/j.otot.2006.03.001
17 Giannetti AV, Guimarães RE, Santiago AP, Perpétuo FO, Machado MA. A tomographic study of the skull base in primary spontaneous cerebrospinal fluid leaks. Neuroradiology 2012; 54 (05) 459-466
18 Lopatin AS, Kapitanov DN, Potapov AA. Endonasal endoscopic repair of spontaneous cerebrospinal fluid leaks. Arch Otolaryngol Head Neck Surg 2003; 129 (08) 859-863
19 Shofty B, Ben-Sira L, Constantini S, Freedman S, Kesler A. Optic nerve sheath diameter on MR imaging: establishment of norms and comparison of pediatric patients with idiopathic intracranial hypertension with healthy controls. AJNR Am J Neuroradiol 2012; 33 (02) 366-369
20 Aaron G, Doyle J, Vaphiades MS, Riley KO, Woodworth BA. Increased intracranial pressure in spontaneous CSF leak patients is not associated with papilledema. Otolaryngol Head Neck Surg 2014; 151 (06) 1061-1066
21 Carrau RL, Snyderman CH, Kassam AB. The management of cerebrospinal fluid leaks in patients at risk for high-pressure hydrocephalus. Laryngoscope 2005; 115 (02) 205-212
22 Psaltis AJ, Schlosser RJ, Banks CA, Yawn J, Soler ZM. A systematic review of the endoscopic repair of cerebrospinal fluid leaks. Otolaryngol Head Neck Surg 2012; 147 (02) 196-203