2025 Poster Presentations
P268: MULTIPLE SPONTANEOUS SKULL BASE CEREBROSPINAL FLUID LEAKS: A SINGLE INSTITUTION EXPERIENCE CONSIDERING RISK FACTORS, RECURRENCE, AND SURGICAL CONSIDERATIONS
Patrick Opperman, MD; William Thorell, MD; Daniel Surdell, MD; University of Nebraska Medical Center
Spontaneous cerebrospinal fluid (CSF) leakage from a skull base defect has been considered uncommon, but recent studies have suggested an increasing identification of these leaks and increasing rates of surgical intervention over the past twenty years. These patients may present with otorrhea or rhinorrhea secondary to a connection between the subarachnoid space and the tympanomastoid cavity of the lateral skull base or the sinonasal corridor via the anterior skull base. Spontaneous CSF leakage falls under the guise of nontraumatic etiologies for CSF leak. It is believed that patients with spontaneous CSF leaks without any other apparent etiology may have elevated intracranial pressure. This suggests a possible association with idiopathic intracranial hypertension (IIH). These patients may be obese, suffer from obstructive sleep apnea, and are often female. There have been several prior case reports that have discussed patients with spontaneous CSF leaks to identify a link with specific risk factors and risk of recurrence. A few studies have suggested an association with IIH, but there remains a population of patients with spontaneous CSF leaks without IIH and identifying their risk factors is important. Currently, we have cared for seven patients with multiple spontaneous CSF leaks with associated skull base defects. Our aim is to delineate our institutional experience caring for patients with multiple CSF leaks with associated skull base defects, possible associated risk factors, timeline for surgical intervention, and recurrence.