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Show Poster 269 Brain MRV predicts the postoperative risk of recurrence of spontaneous cerebro-spinal fluid (CSF) leaks Bryce Buchowicz1, Amit Saindane2, Samuel Bidot3, Benson Chen4, Nancy Newman4, Valerie Biousse4 1 Emory University Medical School, Emory Eye Center, Atlanta, Georgia, USA, 2Emory University School of Medicine, Emory Diagnostic Radiology, Atlanta, Georgia, USA, 3Emory University School of Medicine, Emory Department of Pathology, Atlanta, Georgia, USA, 4 Emory University School of Medicine, Emory Eye Center, Atlanta, Georgia, USA Introduction: A relationship between idiopathic intracranial hypertension (IIH) and spontaneous skull base CSF leaks has been proposed by which the CSF leak acts as a release valve, improving symptoms/signs (papilledema) of elevated increased intracranial pressure (ICP), but making the diagnosis of IIH challenging. Patients with undiagnosed IIH have an increased risk of raised ICP with papilledema and recurrent CSF leak after leak repair, making treatment challenging. Our goal was to assess whether radiographic signs of ICP predict postoperative recurrence of spontaneous CSF leaks. Methods: Retrospective review of demographics, fundus examination and pre-surgical brain MRI/MRV findings in patients seen at our institution from 10/2013-09/2019 for spontaneous CSF leak repair. Results: 72 spontaneous CSF leak patients (median [IQR]: 51 [46-63] years; BMI:36 [22-63] kg/m2; 94% women; 58% black; 11% with known preexistent IIH) with brain MRI/MRV were included. Bilateral transverse venous sinus stenoses (TVSS) were more frequent (83% versus 49%, p=0.02) and degree of stenosis was higher (median: 65% versus 10%, p=0.01) in patients with either papilledema or recurrent CSF leak. Of these 72 patients, 60 had a CSF leak repair without prior or simultaneous CSF diversion procedure, of which 11 had a recurrence; patients with TVSS were 8.2 times (95% CI: 1.35-157.8) more likely to develop a recurrence (p=0.05) after a median follow-up of 7.7 [2.0-16.2] months. Other radiographic signs of raised ICP were similar in both groups: [cephaloceles, osseous defects: 89%/75%; empty sella: 89%/81%; enlarged Meckle's cave: 67%/67%; globe flattening: 29%/35%; prominent perioptic CSF space: 44%/50%, of patients with recurrent CSF leak/papilledema versus non-recurrence/no papilledema]. Conclusions: Spontaneous CSF leak patients who develop papilledema or a recurrent CSF leak following repair of spontaneous CSF leak have a higher prevalence of bilateral TVSS and a higher degree of stenosis. Brain MRV is warranted preoperatively, as bilateral TVSS is a risk factor for postoperative CSF leak recurrence. References: 1. Friedman DI, Liu GT, Digre KB. Revised diagnostic criteria for the pseudotumor cerebri syndrome in adults and children. Neurology2013;81:1159-65 2. Bidot S, Levy J, Saindane A, Oyesiku N, Newman N, Biousse V. Do most patients with a spontaneous cerebrospinal fluid leak have idiopathic intracranial hypertension? J Neuro-ophthalmol2019 (In press). 3. Peker E, Oz D, Kul M, Erdogan M, Oztuna D, Erden M. Neuro-ophthalmologic MRI Findings in the detection of rhinorrhoea aetiology.Neuroophthalmology2019; 43: 244-249 4. Nelson R, Gantz B, Hansen M. The rising incidence of spontaneous cerebrospinal fluid leaks in the United States and the association with obesity and obstructive sleep apnea. Otol Neurotol 2015;36:476-80 5. Bidot S, Saindane AM, Peragallo JH, et al. Brain imaging in idiopathic intracranial hypertension. J Neuroophthalmol2015;35:400-11. Keywords: High intracranial pressure/headache, Neuroimaging, Pseudotumor cerebri, Skull base Financial Disclosures: The authors had no disclosures. Grant Support: None. Contact Information: Bryce Buchowicz, MD- Bryce.e.buchowicz@emory.edu 420 | North American Neuro-Ophthalmology Society |
