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J Neurol Surg B Skull Base 2022; 83(01): 059-065
DOI: 10.1055/s-0040-1716689
Original Article

Decreased Incidence of CSF Leaks after Skull Base Fractures in the 21st Century: An Institutional Report

Brittany M. Stopa 
1   Department of Neurosurgery, Computational Neuroscience Outcomes Center at Harvard, Brigham and Women's Hospital, Boston, Massachusetts, United States
2   Virginia Tech Carilion School of Medicine, Roanoke, Virginia, United States
,
Oscar A. Leyva
1   Department of Neurosurgery, Computational Neuroscience Outcomes Center at Harvard, Brigham and Women's Hospital, Boston, Massachusetts, United States
3   Harvard Medical School, Boston, Massachusetts, United States
,
Cierra N. Harper
1   Department of Neurosurgery, Computational Neuroscience Outcomes Center at Harvard, Brigham and Women's Hospital, Boston, Massachusetts, United States
4   Howard University College of Medicine, Washington, Dist. of Columbia, United States
,
Kyla A. Truman
1   Department of Neurosurgery, Computational Neuroscience Outcomes Center at Harvard, Brigham and Women's Hospital, Boston, Massachusetts, United States
,
C. Eduardo Corrales
3   Harvard Medical School, Boston, Massachusetts, United States
5   Division of Otolaryngology, Brigham and Women's Hospital, Boston, Massachusetts, United States
,
Timothy R. Smith
1   Department of Neurosurgery, Computational Neuroscience Outcomes Center at Harvard, Brigham and Women's Hospital, Boston, Massachusetts, United States
3   Harvard Medical School, Boston, Massachusetts, United States
,
William B. Gormley
1   Department of Neurosurgery, Computational Neuroscience Outcomes Center at Harvard, Brigham and Women's Hospital, Boston, Massachusetts, United States
3   Harvard Medical School, Boston, Massachusetts, United States
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Abstract

Objectives Cerebrospinal fluid (CSF) leaks are a possible complication in patients with skull base fractures (SBFs). The widely cited incidence of CSF leaks is 10 to 30% in SBF patients; however, this estimate is based only on a few outdated studies. A recent report found CSF leaks in <2% SBF patients, suggesting the incidence may be lower now. To investigate this, we report here our institutional series.

Design This study is a retrospective chart review.

Setting The study was conducted at two major academic medical centers (2000–2018).

Participants Adult patients with SBF were included in this study.

Main Outcome Measures Variables included age, gender, CSF leak within 90 days, management regimen, meningitis within 90 days, and 1-year mortality.

Results Among 4,944 patients with SBF, 199 (4%) developed a CSF leak. SBF incidence was positively correlated with year of clinical presentation (r-squared 0.78, p < 0.001). Among CSF leaks, 42% were conservatively managed, 52% were treated with lumbar drain, and 7% required surgical repair. Meningitis developed in 28% CSF leak patients. The 1-year mortality for all SBF patients was 11%, for patients with CSF leaks was 12%, and for patients with meningitis was 16%.

Conclusion In the largest institutional review of SBF patients in the 21st century, we found CSF leak incidence to be 4%. This is lower than the widely cited range of 10 to 30%. Nevertheless, morbidity and mortality associated with this complication remains clinically significant, and SBF patients should continue to be monitored for CSF leaks. We provide here our institutional treatment algorithm for these patients that may help to inform the treatment strategy at other institutions.

Keywords

CSF leak - cerebrospinal fluid otorrhea - cerebrospinal fluid rhinorrhea - skull base fracture - basilar skull fracture

Note

Portions of this work were presented at North America Skull Base Society Meeting (February 7–9, 2020, San Antonio, Texas, United States), and New England Neurosurgical Society Meeting (June 27–29, 2019, Brewster, MA, United States). Portions of this work were also presented at the American Association of Neurological Surgery Meeting (April 25–29, 2020).




Publication History

Received: 01 April 2020

Accepted: 25 July 2020

Article published online:
16 October 2020

© 2020. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

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