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Video

Otology/Neurotology

(A863) Risk Reduction of Recurrent Spontaneous Cerebrospinal Fluid Leaks with Postoperative Intracranial Pressure Management

Monday, October 13, 2025
12:00 PM - 1:00 PM EDT
Location: OTO EXPO, Posters
Disclosure(s):
Prishae M. Wilson, BS: No relevant relationships to disclose.
Ryan Hossain, BS: No relevant relationships to disclose.
Madison Doucette, BS: No relevant relationships to disclose.
Bastien A. Valencia, MD: No relevant relationships to disclose.
Mallory J. Raymond, MD: No relevant relationships to disclose.


Introduction: Idiopathic intracranial hypertension is associated with spontaneous cerebrospinal fluid (sCSF) leaks at the skull base, for which surgical repair is advised. Evidence regarding the efficacy of CSF pressure-reducing interventions in preventing recurrence after repair is limited for the anterior skull base and remains unknown for the lateral skull base. Therefore, this systematic review aimed to evaluate the impact of postoperative CSF pressure-reducing interventions on the risk of lateral skull base sCSF leak recurrence after repair.

Methods: In accordance with PRISMA guidelines, a search of Ovid MEDLINE, Embase, Web of Science, Cochrane Central Register of Controlled Trials, and Scopus from inception to October 10, 2024, was conducted by a research librarian to identify any article reporting on adult patients undergoing lateral skull base sCSF leak repair and in which the use of intracranial pressure-reducing medications or CSF diversion or lack thereof was stated. The primary outcome was the recurrence rate following surgery.

Results: The search identified 7,074 articles, of which 21 with 287 sCSF leak patients were included. Sex was reported in 20 studies, with 177 patients (61.7%) identified as female. There were 24 recurrences. Postoperative therapies included Diamox alone for 15 patients, lumbar drainage with Diamox for 5 patients, lumbar drainage alone for 56 patients, no intervention for 205 patients, and shunting alone for 6 patients. The pooled recurrence rates were 6.67% for Diamox (95% CI: 1.19%–29.82%), 0.00% for combined therapy (95% CI: 0.00%–43.45%), 5.36% for lumbar drainage (95% CI: 1.84%–14.61%), 9.27% for no intervention (95% CI: 6.01%–14.02%), and 16.67% for shunting (95% CI: 3.01%–56.35%). No significant differences were found between interventions (p = 0.80), and heterogeneity was minimal (I² = 0.00%).

Conclusions: There is no strong evidence to support the use of postoperative CSF pressure-reducing interventions in reducing the risk of recurrent lateral skull base sCSF leaks after repair.