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Impact of Obesity and Obstructive Sleep Apnea in Lateral Skull Base Cerebrospinal Fluid Leak Repair. | LitMetric

AI Article Synopsis

  • - The study aimed to examine the prevalence and effects of obstructive sleep apnea (OSA) and obesity among patients undergoing lateral skull base cerebrospinal fluid leak repair (LSBR) from 2013-2018, analyzing various factors and outcomes.
  • - A total of 94 patients were reviewed, finding that those with spontaneous cerebrospinal fluid leaks (sCSFL) had higher rates of Class III obesity and OSA, along with specific imaging findings that indicated elevated intracranial pressure.
  • - The results indicated that elevated intracranial pressure was a predictor of surgical outcomes, as it was linked to a greater need for revision surgeries or shunt placements in patients with sCSFL.

Article Abstract

Objective: To investigate the prevalence and impact of obstructive sleep apnea (OSA) and obesity in lateral skull base cerebrospinal fluid leak repair (LSBR) of various etiologies.

Methods: Retrospective case review at a tertiary skull base center was conducted of consecutive adults undergoing LSBR via transmastoid, middle cranial fossa, or combined approach between 2013-2018. The following data were collected: demographics, comorbidities, radiology and intraoperative findings, and surgical outcomes including complications and need for revision surgery or shunt placement. Patients with incomplete data or leaks following skull base surgery, trauma or chronic ear disease were excluded.

Results: Ninety-four patients (67.4% female, mean age 53.5 ± 12.9 years) underwent repair for spontaneous (sCSFL, 44%) and other etiology (nsCSFL) leaks. nsCSFL served as a comparison group consisting of leaks status-post lateral skull base surgery, temporal bone fractures, and chronic ear disease. Class III obesity (P = .02), OSA (P = .03), and imaging findings of empty sella (OR = 3.32, P = .02), and skull base thinning including contralateral tegmen thinning (31%, OR = 4.3, P = .02), arachnoid granulations (26%, OR = 4.35, P = .02), and superior canal dehiscence (15.8%, OR = 8.57, P = .04) were more common in sCSFL. Four patients (4.2%) required surgical revision for recurrence, and another four (4.2%) resolved with shunting. Evidence of elevated intracranial hypertension was present in nine patients with sCSF leaks and was predictive of need for revision or shunt procedures (P < .01).

Conclusion: Obesity, OSA, and imaging consistent with elevated intracranial pressures were more common among patients with sCSFL. Elevated intracranial pressure predicted outcomes following multilayer repair of spontaneous CSF leaks LEVEL OF EVIDENCE: 4 Laryngoscope, 130:2234-2240, 2020.

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Source
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8054035PMC
http://dx.doi.org/10.1002/lary.28421DOI Listing

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