2025 Proffered Presentations
S294: REDUCTION OF CEREBROSPINAL FLUID LEAKS IN IDIOPATHIC INTRACRANIAL HYPERTENSION WITH GLUCAGON-LIKE PEPTIDE-1 RECEPTOR AGONIST USE
Adam S Vesole, MD1; Steven A Gordon, MD1; Jonathan Forbes, MD2; Norberto Andaluz, MD2; Daniel Q Sun, MD1; 1Department of Otolaryngology-Head & Neck Surgery, University of Cincinnati College of Medicine; 2Department of Neurosurgery, University of Cincinnati College of Medicine
Introduction: Persistently elevated intracranial pressure (ICP) secondary to idiopathic intracranial hypertension (IIH) is an increasingly recognized risk factor for anterior and lateral skull base cerebrospinal fluid (CSF) leaks. A recent randomized control trial (Mithcell et al. 2023) demonstrated a significant reduction of ICP in IIH with the use glucagon-like peptide-1 (GLP-1) receptor agonists (e.g., semaglutide), a therapeutic agent for diabetes mellitus and weight loss. No study to date has evaluated the effect of GLP-1 agonists on skull base CSF leaks in IIH.
Methods: A multi-institutional national database (TriNetX) was utilized to identify IIH patients (ICD-10 G93.2) with versus without concurrent GLP-1 agonist use. Propensity score matching was performed to control for potential confounding variables (age, sex, diabetes mellitus, obesity, obstructive sleep apnea; Table 1). The rate of spontaneous cranial CSF leak (ICD-10 G96.01) and anterior/lateral skull base CSF leak repair (CPT 62100, 69670, 31290, or 31291) were evaluated between each group over an approximately 1.5-year period.
Results: Compared to IIH patients not taking GLP-1 agonists (n=6,987), IIH patients taking GLP-1 agonists (n=6,987) were 33% less likely to develop a spontaneous cranial CSF leak (OR 0.67, 95% CI [0.50- 0.89]) and 52% less likely to undergo skull base CSF leak repair (OR 0.44, 95% CI [0.25- 0.93]; Figure 1). BMI in the GLP-1 agonist cohort was reduced by 4.5% over a 3-year period (BMI 42.1 to 40.2) compared to a 1.5% decrease in the non-GLP-1 cohort (BMI 38.5 to 37.9).
Conclusions: We present the first study demonstrating a significantly lower incidence of spontaneous cranial CSF leaks in IIH associated with GLP-1 agonist use. Further, IIH patients using GLP-1 agonists were significantly less likely to undergo anterior and/or lateral skull base CSF leak repair. These promising findings, in conjunction with previous studies exhibiting a sustained reduction in ICP with GLP-1 agonist use, suggest that GLP-1 agonists may be an effective therapeutic agent in CSF leak prophylaxis and resolution in IIH. Future prospective and randomized control studies are needed to better elucidate the relationship of GLP-1 and CSF leaks in IIH.
