Intracranial hypertension management in spontaneous skull base meningoencephaloceles

Abstract

Abstract Spontaneous meningoencephaloceles are often associated with cerebrospinal fluid leak and intracranial hypertension. There is a data scarcity concerning the need for insertion of a cerebrospinal diversion device in these situations. Therefore, we provided an analysis of our patients with spontaneous skull base meningoencephaloceles (MEC) whether their definitive surgical treatment requires management of elevated intracranial pressure (ICP) or not. Retrospective evaluation and data collection of 10 subjects with spontaneous MEC was held. Among others, attention was paid to measuring of ICP, prior interventions, treatment with acetazolamide, characteristics for long term elevated ICP, etc. Our own indications for cerebrospinal fluid (CSF) diversion and use of postoperative external lumbar drain (ELD) underwent analysis as well. The sphenoid region was the most common location of MEC. CSF leak was diagnosed in all subjects. The most common graphical signs of elevated ICP were empty sella and arachnoid pits, both of which were presented in 90% of cases. A lumbar puncture with opening pressure measurement was performed in 7 patients. Ventriculoperitoneal shunt insertion was indicated in 4 cases prior to and in two cases after skull base repair. Two postoperative CSF leaks were managed with ELD and subsequent shunt installation. Spontaneous MECs are often associated with CSF leak. The ICP assessment should be a standard of care to ensure MEC operative repair success. Insertion of a CSF diversion device must be considered where direct or indirect signs of ICH are presented.