Predictors of Cerebrospinal Fluid Leak in Patients Receiving Surgical Treatment for Idiopathic Intracranial Hypertension

Objectives: Idiopathic intracranial hypertension (IIH) is an increasingly common pathology characterized by headaches, papilledema, and transient vision loss. Patients are often medically managed, but in refractory or emergent cases may be considered for surgical interventions such as ventriculoperitoneal (VP) shunt placement or optic nerve sheath fenestration (ONSF). Though these standard procedures have been performed for many years, some patients develop cerebrospinal fluid (CSF) leaks which can complicate postoperative care and necessitate further surgical intervention. In this study, we aim to identify risk factors for CSF leaks in patients receiving surgical management of idiopathic intracranial hypertension.

Methodology: This was a retrospective large cohort study using the National Inpatient Survey (NIS) dataset from 2016 to 2019. The study sample included all patients diagnosed with IIH who received either optic nerve sheath fenestration (ONSF) or cerebrospinal fluid shunt placement. Comorbidities were classified based on the Charlson Comorbidity Index (CCI) mapping of ICD-10 codes. Univariable logistic regression models, accounting for the sample design, were built to determine factors associated with CSF leak.

Results: Overall, 11,070 patients were included in the study with 3,260 having a PLOS. From the univariate analysis it was found that within patients over the age of 80, 8.6% experienced a CSF leak compared to 2.2% (p < 0.001). When examining comorbidities, on univariate analysis diabetes mellitus was associated with increased risk for CSF leak (p = 0.036). There were no significant differences in risk for CSF leak within sex, obesity, and race categories.

Conclusions: Patients receiving surgical interventions for management of IIH were at greater risk for CSF leak depending on age and whether they were diagnosed with diabetes. Care should be taken to appropriately select patients who may require surgical intervention for refractory IIH.

No conflict of interest has been declared by the author(s).

Publication History

Article published online:
05 February 2024