Rasmussen Jordan M, Patel Kautilya R, Surdell Daniel L, Thorell William E, Borg Nicholas, Opperman Patrick J, Casazza Geoffrey, Maxwell Anne K, Barnes Christie, Pate Samuel, Schmidt Cindy M, Sattur Mithun G
College of Medicine, University of Nebraska Medical Center, Omaha, NE, USA.
Department of Neurosurgery, University of Nebraska Medical Center, Omaha, NE, USA.
Interv Neuroradiol. 2025 Feb 6:15910199241311626. doi: 10.1177/15910199241311626.
Idiopathic intracranial hypertension (IIH) is strongly associated with spontaneous skull-base cerebrospinal fluid (CSF) leaks. Venous sinus stenting (VSS) has proven effective for the treatment of IIH. Hence, its role in spontaneous skull-base CSF leaks is being explored actively.
We performed a systematic literature search across EMBASE, MEDLINE, Scopus, The Cochrane Library, and Google Scholar to identify studies reporting the use of VSS for spontaneous skull-base CSF leaks. Studies with pediatric patients, non-English articles, and nonspontaneous leaks were excluded. Failure of treatment (persistence / recurrence of CSF leak) was regarded as the primary outcome.
Eight studies with 62 patients undergoing VSS for spontaneous skull-base CSF leaks were included. Mean age of the patients was 51.9 years; 87.5% were females. Obesity was highly prevalent, with a mean body mass index of 33.9 kg/m (4 studies). IIH was noted in 74.6% patients (7 studies). Twenty-six patients (41.9%) underwent VSS alone whereas 36 patients (58.1%) underwent surgical repair + VSS. Seven patients (11.3%) had a failure of treatment. Three failures from one study could not be definitively ascribed to either of the groups. Hence, the estimated failure rate for VSS alone ranged from 18.6% (95% CI [0.02 - 0.46]) to 26.4% (95% CI [0.11 - 0.46]), whereas that for surgical repair + VSS ranged from 5.5% (95% CI [0.00 - 0.16]) to 12.2% (95% CI [0.01 - 0.32]). Furthermore, the estimated rate for resolution of concomitant IIH-related symptoms was 88.7% (95% CI [0.75 - 0.98%]). Majority of the studies did not report any serious complications or mortality related to VSS.
VSS has a potential role in the management of spontaneous skull-base CSF leaks. Its exact indications as a standalone treatment versus as an adjuvant to surgical repair, and the predictors for successful treatment remain to be defined.
特发性颅内高压（IIH）与自发性颅底脑脊液（CSF）漏密切相关。静脉窦支架置入术（VSS）已被证明对IIH的治疗有效。因此，正在积极探索其在自发性颅底CSF漏中的作用。
我们在EMBASE、MEDLINE、Scopus、Cochrane图书馆和谷歌学术上进行了系统的文献检索，以确定报告使用VSS治疗自发性颅底CSF漏的研究。排除涉及儿科患者、非英文文章和非自发性漏的研究。治疗失败（CSF漏持续/复发）被视为主要结局。
纳入了8项研究，共62例患者接受了VSS治疗自发性颅底CSF漏。患者的平均年龄为51.9岁；87.5%为女性。肥胖非常普遍，平均体重指数为33.9 kg/m（4项研究）。74.6%的患者存在IIH（7项研究）。26例患者（41.9%）仅接受VSS治疗，而36例患者（58.1%）接受了手术修复+VSS治疗。7例患者（11.3%）治疗失败。一项研究中的3例失败不能明确归因于任何一组。因此，单独VSS的估计失败率为18.6%（95%CI[0.02-0.46]）至26.4%（95%CI[0.11-0.46]），而手术修复+VSS的失败率为5.5%（95%CI[0.00-0.16]）至12.2%（95%CI[0.01-0.32]）。此外，伴随的IIH相关症状缓解的估计率为
