Acetazolamide for high intracranial pressure cerebrospinal fluid leaks.
BACKGROUND
Acetazolamide has become a standard treatment for cerebrospinal fluid (CSF) leaks associated with intracranial hypertension. The purpose of the current study was to evaluate the effectiveness of acetazolamide at decreasing elevated CSF pressure in this patient population.


METHODS
Prospective evaluation and data collection of high intracranial pressure CSF leaks was performed. Subjects underwent CSF diversion and postoperative assessment of pressure changes via a standard protocol. Lumbar drains or ventriculostomies were clamped on postoperative day 2 for 4 hours prior to assessment with a manometer. Acetazolamide (500 mg) was administered orally immediately following the recording and CSF pressure was measured after 4 hours. Data regarding demographics, etiology of CSF leak, body mass index (BMI), location and size of defect, and clinical follow-up were also collected.


RESULTS
Thirty-six patients (average age 50 years) with 42 CSF leaks (39 spontaneous, 3 traumatic) and an average BMI of 36.1 were evaluated. Success rate of primary repair was 94.4%, but all patients were effectively sealed with subsequent endoscopic reconstruction (average 80 weeks follow-up). Intracranial pressure (cm H2 O) via lumbar puncture or ventriculostomy (n = 2) after clamping was 32.0 ± 7.4. Administration of acetazolamide significantly decreased intracranial pressure to 21.9 ± 7.5 in the 4-6 hour time frame studied (p < 0.0001).


CONCLUSION
This study provides some of the first direct evidence of decreased intracranial pressure associated with the oral administration of acetazolamide. In combination with the excellent endoscopic repair outcomes noted in a high risk population, this evidence supports the routine use of acetazolamide in patients with high intracranial pressure CSF leaks.
['Chaaban|Mohamad R|MR|', 'Illing|Elisa|E|', 'Riley|Kristen O|KO|', 'Woodworth|Bradford A|BA|']
D000086:Acetazolamide D000284:Administration, Oral D000328:Adult D000368:Aged D002257:Carbonic Anhydrase Inhibitors D065634:Cerebrospinal Fluid Leak D002559:Cerebrospinal Fluid Rhinorrhea D004724:Endoscopy D005260:Female D005500:Follow-Up Studies D006801:Humans D019586:Intracranial Hypertension D007427:Intracranial Pressure D008297:Male D008875:Middle Aged D011446:Prospective Studies D019651:Reconstructive Surgical Procedures D014696:Ventriculostomy D055815:Young Adult
acetazolamide cerebrospinal fluid leak intracranial hypertension spontaneous CSF leak repair CSF rhinorrhea encephalocele endoscopic sinus surgery pseudotumor cerebri skull base defect