crossem.blogg.se

Appropriate management of skull base CSF leaks is imperative due to the potentially life-threatening complications that can arise, including meningitis and herniation of brain structures. The increased intracranial pressure (ICP) from IIH could lead to development of dural defects in the anterior (typically from the sphenoid sinus, frontal sinus, or cribriform plate) or lateral (most commonly tegmen tympani) skull base and result in leakage of CSF through the nasal passages or into the middle ear.

These spontaneous CSF leaks most likely occur secondary to idiopathic intracranial hypertension (IIH), for which high body-mass index and female sex are correlated risk factors. Neuraxial anesthesia can safely be performed in pregnant individuals with spontaneous skull base CSF leakage, but further studies are needed to determine the safest mode of delivery in these patients.Ĭerebrospinal fluid (CSF) leaks from the skull base most often results from head and/or maxillofacial trauma, iatrogenically through surgery, congenitally through encephaloceles, or as anticipated from otolaryngologic and/or neurosurgical procedures, but can also occur spontaneously in some cases without any known precipitating event. Pregnancy may exacerbate skull base CSF leaks, requiring careful management with a multidisciplinary team. The patient had spontaneous marked improvement of her symptoms postpartum. A planned cesarean section was performed at 38 weeks under spinal anesthesia. The patient was neurologically stable without signs of meningitis thus, management was focused on symptomatic alleviation. Brain imaging revealed a bony defect of the sphenoid sinus with a meningoencephalocele and a partially empty sella, consistent with CSF leakage from a skull base defect. Case presentationĪ 31-year-old G4P1021 at 14 weeks developed debilitating headaches and CSF rhinorrhea. Skull base CSF leaks are rarely reported in pregnancy but pose unique challenges for obstetricians and anesthesiologists. Idiopathic intracranial hypertension can lead to dural defects and spontaneous leakage of cerebrospinal fluid (CSF) from the skull base.