Contemporary Evaluation and Management of Lateral Skull Base Spontaneous Cerebrospinal Fluid Leaks

PROGRAM DESCRIPTION: The incidence of lateral skull base spontaneous cerebrospinal fluid (sCSF) leaks has been rising, but diagnostic and management practices still vary considerably. While the association between lateral skull base sCSF leaks and idiopathic intracranial hypertension (IIH) is well established, the underlying etiology of leaks for many patients remains unknown. Additionally, though repair of sCSF leaks has traditionally been recommended to reduce the risk of meningitis, quantifying the risk reduction has remained elusive, and there exist diverse opinions on the timing of and approach to repair. Finally, reduction of intracranial pressure pre- and post-operatively, both in patients with and without IIH, remains controversial. This panel brings together neurotologists and neurologists with clinical and academic expertise in the care of patients with lateral skull base sCSF leaks to discuss these controversies through a case-based approach with a focus on answering when to be suspicious of and how to evaluate for a sCSF leak and IIH and how to manage both conditions.

OUTCOME OBJECTIVE 1: Recognize what should raise suspicion of lateral skull base sCSF leaks and IIH

OUTCOME OBJECTIVE 2: Identify the highest yield laboratory, radiographic and procedural testing

OUTCOME OBJECTIVE 3: Develop patient-centered, data-driven approaches to sCSF leak repair

BACKGROUND STATEMENT: Lateral skull base sCSF leaks can present similarly to chronic serous otitis media and might often be confused. Understanding the presentation, risk factors, evaluation and management of these leaks is critical to achieve optimal patient outcomes

Comprehensive Otolaryngology Track Statement : Spontaneous CSF leaks and IIH have associations with obstructive sleep apnea, superior semicircular canal dehiscence, pulsatile tinnitus, atypical facial pain and headache, all which comprehensive otolaryngologists may evaluate and manage.