Zocchi Jacopo, Pietrobon Giacomo, Lepera Davide, Gallo Stefania, Russo Federico, Volpi Luca, Pellini Raul, Bignami Maurizio, Castelnuovo Paolo
Division of Otorhinolaryngology, Department of Biotechnology and Life Sciences, University of Insubria, Ospedale di Circolo e Fondazione Macchi, Varese, Italy.
Department of Otolaryngology-Head and Neck Surgery, Regina Elena National Cancer Institute IRCCS, Rome, Italy.
Laryngoscope. 2021 Feb;131(2):E401-E407. doi: 10.1002/lary.28828. Epub 2020 Jun 18.
Spontaneous cerebrospinal fluid (CSF) leaks are a rare but insidious clinical entity. In the recent literature, their pathogenesis has been linked with idiopathic intracranial hypertension (IIH). Considering a worse surgical outcome compared to traumatic leaks, a medical treatment of the underlying IIH has been suggested in order to prevent relapses. Nevertheless, some aspects of this rare pathology remain unclear. We report our long experience in the management of spontaneous CSF leaks.
A retrospective evaluation of all patients with spontaneous CSF leaks treated from 1998 to 2018 in a tertiary referral center was carried out. All patients received surgery without any adjuvant routine medical treatment. Epidemiological and clinical data were reviewed. A telephone survey was conducted to investigate IIH-related symptoms in this population.
One hundred sixty-seven patients and 195 procedures were included in the study. The total rate of failure after surgical treatment was 9%. Eight patients suffered a relapse in the same site (4%, 8 of 195), whereas seven patients experienced a relapse in a different site (4%, 7 of 167). Twenty-nine percent of the population interviewed referred at least one IIH-related symptom.
Spontaneous CSF leaks represent a complex pathology that need a multidisciplinary evaluation. Surgical treatment seems to guarantee favorable results in most of the patients. Despite this, a not negligible percentage of patients experienced a relapse during a long-term follow-up. Further studies are needed to reach a deeper understanding of the presentation and course of this particular condition.
4 Laryngoscope, 131:E401-E407, 2021.
自发性脑脊液（CSF）漏是一种罕见但隐匿的临床病症。在最近的文献中，其发病机制与特发性颅内高压（IIH）有关。鉴于与创伤性漏相比手术效果更差，有人建议对潜在的IIH进行药物治疗以预防复发。然而，这种罕见病理的一些方面仍不清楚。我们报告我们在自发性脑脊液漏管理方面的长期经验。
对1998年至2018年在一家三级转诊中心接受治疗的所有自发性脑脊液漏患者进行回顾性评估。所有患者均接受手术，未进行任何辅助常规药物治疗。回顾了流行病学和临床数据。进行了电话调查以调查该人群中与IIH相关的症状。
该研究纳入了167例患者和195例手术。手术治疗后的总失败率为9%。8例患者在同一部位复发（4%，195例中的8例），而7例患者在不同部位复发（4%，167例中的7例）。接受访谈的人群中有29%提到至少一种与IIH相关的症状。
自发性脑脊液漏是一种复杂的病症，需要多学科评估。手术治疗似乎能保证大多数患者取得良好效果。尽管如此，仍有不可忽视比例的患者在长期随访中复发。需要进一步研究以更深入地了解这种特殊病症的表现和病程。
4《喉镜》，131:E401 - E407，2021年。
