Department of Otorhinolaryngology-Head and Neck Surgery, University Hospital of Poitiers, Poitiers, France.
Department of Otorhinolaryngology-Head and Neck Surgery, University Hospital of Montpellier, Montpellier, France.
Otolaryngol Head Neck Surg. 2023 Dec;169(6):1647-1653. doi: 10.1002/ohn.414. Epub 2023 Jul 12.
Spontaneous nasal cerebrospinal fluid (CSF) leaks are frequently linked to idiopathic intracranial hypertension (IIH). The objectives of our study were: (1) to determine the rate of transverse venous sinus stenosis (TVSS) in patients with spontaneous nasal CSF leak and in patients with IIH without CSF (controls), and (2) to study the correlation between spontaneous nasal CSF leak and brain imaging features.
A multicenter retrospective case-control study.
Six French tertiary hospitals.
Patients with spontaneous nasal CSF leaks and patients with IIH without nasal CSF leaks (controls) were included. The transverse venous sinus patency was analyzed by magnetic resonance imaging to identify possible stenosis or hypoplasia.
Thirty-two patients with spontaneous nasal CSF leaks and 32 controls were included. TVSS was significantly more frequent in patients with spontaneous nasal CSF leaks than in controls (p = .029). Univariate analysis indicated that TVSS (odds ratio, OR: 4.2; 95% confidence interval, CI [1.352-14.915]; p = .017) and arachnoid granulations (OR: 3; 95% CI [1.065-8.994]; p = .042) were risk factors for spontaneous nasal CSF leak. In multivariate analysis, TVSS and arachnoid granulations were independent risk factors of nasal CSF leak (OR: 5.577, 95% CI [1.485-25.837], p = .016; and OR: 4.35, 95% CI [1.234-17.756], p = .029, respectively).
This multicenter case-control study shows that TVSS is an independent risk factor for CSF leak in patients with IIH. Stenosis management by interventional radiology may be proposed postoperatively to increase the success of IIH surgical treatment or preoperatively to reduce the need for surgery.
自发性鼻脑脊液（CSF）漏常与特发性颅内高压（IIH）有关。本研究的目的是：（1）确定自发性鼻 CSF 漏患者和无 CSF 的 IIH 患者（对照组）中横窦狭窄（TVSS）的发生率；（2）研究自发性鼻 CSF 漏与脑影像学特征之间的相关性。
多中心回顾性病例对照研究。
六家法国三级医院。
纳入自发性鼻 CSF 漏患者和无鼻 CSF 漏的 IIH 患者（对照组）。通过磁共振成像分析横窦通畅情况，以确定可能存在狭窄或发育不良。
纳入 32 例自发性鼻 CSF 漏患者和 32 例对照组。与对照组相比，自发性鼻 CSF 漏患者的 TVSS 发生率明显更高（p=0.029）。单因素分析表明，TVSS（优势比，OR：4.2；95%置信区间，CI [1.352-14.915]；p=0.017）和蛛网膜颗粒（OR：3；95%CI [1.065-8.994]；p=0.042）是自发性鼻 CSF 漏的危险因素。多因素分析表明，TVSS 和蛛网膜颗粒是鼻 CSF 漏的独立危险因素（OR：5.577，95%CI [1.485-25.837]，p=0.016；OR：4.35，95%CI [1.234-17.756]，p=0.029）。
这项多中心病例对照研究表明，TVSS 是 IIH 患者 CSF 漏的独立危险因素。介入放射学治疗狭窄可能会增加 IIH 手术治疗的成功率，或者在术前减少手术的需要。
