Evaluation of postoperative intracranial pressure in patients with radiological diagnosis of idiopathic intracranial hypertension

Abstract

Objective: This study aimed to assess postoperative intracranial pressure in patients with clinical and/or radiological features of idiopathic intracranial hypertension (IIH) undergoing endoscopic endonasal surgery for primary cerebrospinal fluid (CSF) leak repair.

Methods: Data was prospectively collected from 9 patients diagnosed with CSF nasal leaks who underwent corrective endonasal surgery between January 1, 2021, and October 31, 2022. Postoperative intracranial pressure was measured via lumbar puncture at least one month after surgery. Preoperative and postoperative MRI scans were compared to evaluate changes.

Results: Postoperative lumbar puncture revealed elevated intracranial pressure in 67 % of patients, and 100 % showed persistent signs of intracranial hypertension on MRI.

Conclusion: Managing elevated intracranial pressure in patients with CSF nasal leaks should be prioritized alongside surgical correction. Consideration of permanent peritoneal shunt or pharmacological treatment may be necessary for patients with classic IIH phenotype. Longitudinal studies are essential for further understanding long-term outcomes.

Keywords: CSF leak; Endonasal surgery; Intracranial hypertension; Permanent peritoneal shunt.