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Clinical Research
Uncorrected Proof. Available online 7 May 2023
Spontaneous CSF fistula as a manifestation of idiopathic intracranial hypertension
Fistula espontánea de LCR como manifestación de la hipertensión intracraneal idiopática
Samsara López Hernándezc, Carlos Alberto Rodríguez Ariasa,b,
Corresponding author
carroda@orange.es

Corresponding author.
, Jaime Santos Pérezb,d, Mario Martínez-Galdámeze, Adrián Fernández Garcíaa, Herbert Daniel Jiménez Zapataa,b
a Servicio de Neurocirugía, Hospital Clínico Universitario de Valladolid, Valladolid, Spain
b Unidad de Base de Cráneo, Hospital Clínico Universitario de Valladolid, Valladolid, Spain
c Servicio de Urgencias, Hospital de Medina del Campo, Medina del Campo, Valladolid, Spain
d Servicio de Otorrinolaringología, Hospital Clínico Universitario de Valladolid, Valladolid, Spain
e Unidad de Neurorradiología Intervencionista, Hospital Clínico Universitario de Valladolid, Valladolid, Spain
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Table 1. Location of the fistula and IIH clinical data.
Abstract
Introduction

Spontaneous cerebrospinal fluid (CSF) fistula, of unknown origin, is a rare condition whose aetiology is increasingly related to idiopathic intracranial hypertension (IIH). This study tries to raise awareness that they should not be considered as two different processes, but that fistulas can be a form of debut, requiring a study and subsequent treatment. Repair techniques are described, as well as the study of HII.

Results

We treated 8 patients, 5 women and three men, aged between 46 and 72 years, with a diagnosis of spontaneous CSF fistula, four nasal and four otics who underwent surgical treatment. After repair, a diagnostic study was performed for IIH by MRI and Angio-MRI, presenting in all cases a transverse venous sinus stenosis. The intracranial pressure values obtained by lumbar puncture showed values of 20 mm Hg or higher. All patients were diagnosed with HII. The one-year follow-up did not reveal any recurrence of the fistulas, maintaining a control of the HII.

Conclusion

Despite their low frequency of both cranial CSF fistula and IIH, an association of both conditions should be considered by continuing the study and surveillance of these patients after fistula closure.

Keywords:
Rhinoliquorrhea
Nasal surgical procedures
Otic surgical procedures
Idiopathic intracranian hypertension
Resumen
Introducción

La fistula espontanea de líquido cefalorraquídeo (LCR), de origen desconocido, es una afección poco frecuente cuya etiología se relaciona cada vez más con la hipertensión intracraneal idiopática (HII). Este estudio trata de concienciar que no deben considerase como dos procesos distintos, sino que las fistulas pueden ser una forma de debut, requiriendo un estudio y tratamiento posterior. Se describen las técnicas de reparación, así como el estudio de la HII.

Resultados

Se trataron 8 pacientes, 5 mujeres y tres hombres, con edades comprendidas entre 46 y 72 años, con diagnóstico de fistula espontánea de LCR, cuatro nasales y cuatro óticas a los que se le sometió a tratamiento quirúrgico. Tras la reparación se realizó un estudio diagnóstico para la HII mediante RMN y Angio-RM, presentando en todos los casos una estenosis de seno venoso transverso. Los valores de presión intracraneal obtenidos mediante punción lumbar mostraron valores de 20 mm Hg o superiores. Todos los pacientes fueron diagnosticados de HII. El seguimiento a un año no reveló ninguna recidiva de las fistulas, manteniendo un control de la HII.

Conclusión

A pesar de su escasa frecuencia tanto de las fistula craneales de LCR como de la HII, debe considerarse una asociación de ambas afecciones continuando el estudio y vigilancia de estos pacientes tras el cierre de la fístula.

Palabras clave:
Rinolicuorrea
Procedimiento quirúrgico nasal
Procedimiento quirúrgico ótico
Fistula
Hipertensión intracraneal idiopática

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