Rasmussen Jordan M, Patel Kautilya R, Surdell Daniel L, Opperman Patrick J, Casazza Geoffrey, Maxwell Anne K, Schmidt Cindy M, Sayles Harlan R, Sattur Mithun G
School of Medicine, University of Nebraska Medical Center, Omaha, NE, USA.
Department of Neurosurgery, University of Nebraska Medical Center, Omaha, NE, USA.
Neurosurg Rev. 2025 Jun 6;48(1):490. doi: 10.1007/s10143-025-03649-0.
Spontaneous middle cranial fossa cerebrospinal fluid (CSF) leaks can be treated surgically by middle cranial fossa (MCF), transmastoid (TM), or combined approaches. Efficacy of these approaches and the factors influencing CSF leak recurrence rates need further clarity. A literature search was conducted across EMBASE, MEDLINE, Scopus, and the Cochrane Library. Case reports, non-English articles, and studies with pediatric patients alone were excluded. Proportional meta-analysis was used to estimate the CSF leak recurrence rates. Influence of associated comorbidities and adjuvant treatment measures was studied. Forty-five studies with 990 patients were included. 52% patients were females. Mean BMI was 35.8 kg/m². IIH and OSA were noted in 23.6% (8 studies) and 49.5% (6 studies) of patients, respectively. Mean opening pressure (8 studies) was 24.29 cm HO. Numbers of sides treated by MCF, TM and combined approach were 555 (53%), 125 (12%) and 155 (15%), respectively. The remaining patients (19.8%) underwent less common procedures including middle ear-mastoid obliteration and external auditory-canal plugging. Meta-analysis estimated a recurrence rate of 6.76% over a mean follow-up duration of 21.6 months. The mean time to recurrence was 13.5 months. Overall complication rate was 1.3%. The estimated recurrence rates for MCF, TM and combined approaches were 3.8%, 11.8% and 11.4% respectively. The presence of multiple defects, encephalocele, comorbidities like obesity, IIH or OSA, and use of adjuvant measures like acetazolamide, lumbar drain and ventriculoperitoneal shunt did not influence the recurrence rates significantly. Different surgical approaches (MCF / TM / combined) for repair of spontaneous MCF-CSF leaks are safe and effective. The presence of multiple defects, encephalocele, comorbidities like obesity, IIH and OSA, and the use of adjuvant measures were not found to have a significant influence on the CSF leak recurrence rates. These factors require closer and a more rigorous study. Clinical trial number not applicable.
自发性中颅窝脑脊液漏可通过中颅窝（MCF）、经乳突（TM）或联合入路进行手术治疗。这些入路的疗效以及影响脑脊液漏复发率的因素尚需进一步明确。我们在EMBASE、MEDLINE、Scopus和Cochrane图书馆进行了文献检索。排除了病例报告、非英文文章以及仅涉及儿科患者的研究。采用比例荟萃分析来估计脑脊液漏的复发率。研究了相关合并症和辅助治疗措施的影响。纳入了45项研究，共990例患者。52%的患者为女性。平均体重指数为35.8kg/m²。分别有23.6%（8项研究）和49.5%（6项研究）的患者存在特发性颅内高压（IIH）和阻塞性睡眠呼吸暂停（OSA）。平均初压（8项研究）为24.29cm水柱。采用MCF、TM和联合入路治疗的侧数分别为555侧（53%）、125侧（12%）和155侧（15%）。其余患者（19.8%）接受了包括中耳-乳突填塞和外耳道堵塞等不太常见的手术。荟萃分析估计，在平均21.6个月的随访期内复发率为6.76%。复发的平均时间为13.5个月。总体并发症发生率为1.3%。MCF、TM和联合入路的估计复发率分别为3.8%、11.8%和11.4%。存在多个缺损、脑膨出、肥胖、IIH或OSA等合并症以及使用乙酰唑胺、腰大池引流和脑室-腹腔分流等辅助措施对复发率无显著影响。修复自发性中颅窝脑脊液漏的不同手术入路（MCF/TM/联合）安全有效。未发现存在多个缺损、脑膨出、肥胖、IIH和OSA等合并症以及使用辅助措施对脑脊液漏复发率有显著影响。这些因素需要更密切和更严格的研究。临床试验编号不适用。
