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Review
. 2024 Dec 6;16(12):e75214.
doi: 10.7759/cureus.75214. eCollection 2024 Dec.

Efficacy of Acetazolamide for Treatment of Iatrogenic, Traumatic, and Spontaneous Cerebrospinal Fluid Leaks of the Anterior Skull Base: A Systematic Review

Spencer L Raub  1 , Zachary A Abecassis  1 , Thomas A Hanks  1 , Kyly Hiatt  2 , Aria Jamshidi  1 , Emma Celano  1 , Manny Ferreira  1 , Sam Emerson  1 , Jacob Ruzevick  1
Affiliations
Review

Efficacy of Acetazolamide for Treatment of Iatrogenic, Traumatic, and Spontaneous Cerebrospinal Fluid Leaks of the Anterior Skull Base: A Systematic Review

Spencer L Raub et al. Cureus. .

Abstract

A cerebral spinal fluid (CSF) leak from the anterior skull base is a challenging neurosurgical issue that requires prompt recognition and treatment. Options for treatment include medical and surgical repair. A systematic review was performed screening for both retrospective and prospective clinical studies evaluating the efficacy of acetazolamide in the event of CSF leaks of the anterior skull base. We initially screened a total of 149 studies for inclusion, and 25 of them met the inclusion criteria. We included four studies on iatrogenic CSF leaks caused by surgery of the anterior cranial fossa, three studies on traumatic CSF leaks, and 18 studies on spontaneous CSF leaks caused by idiopathic intracranial hypertension (IIH). In the event of an iatrogenic CSF leak, 68 patients had undergone an endoscopic endonasal approach. CSF diversion and high-volume lumbar puncture were used frequently with adjunct acetazolamide administration. In the event of trauma, 187 patients were evaluated across the three included studies. Acetazolamide treatment was used as a single approach and effectively controlled CSF leaks. For spontaneous CSF leaks, acetazolamide is frequently used to increase the efficacy of surgical repair. Of the 431 patients, 327 received temporary CSF diversion in addition to acetazolamide. Surgical repair was the primary treatment in 277 patients. Acetazolamide should be considered as a treatment option in patients with CSF leak secondary to surgery of the anterior cranial fossa, trauma, and idiopathic causes.

Keywords: acetazolamide; diamox; endoscopic csf leak; spontaneous csf leak; traumatic csf leak.

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Conflict of interest statement

Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work.

Figures

Figure 1
Figure 1. PRISMA flow diagram indicating inclusion and exclusion criteria for selected studies
Source [12]
See this image and copyright information in PMC

References

    1. Surgical outcomes of the endonasal endoscopic approach within a standardized management protocol for repair of spontaneous cerebrospinal fluid rhinorrhea. Kreatsoulas DC, Shah VS, Otto BA, Carrau RL, Prevedello DM, Hardesty DA. J Neurosurg. 2021;134:780–786. - PubMed
    1. Surgical outcomes and postoperative management in spontaneous cerebrospinal fluid rhinorrhea. Jiang ZY, McLean C, Perez C, Barnett S, Friedman D, Tajudeen BA, Batra PS. J Neurol Surg B Skull Base. 2018;79:193–199. - PMC - PubMed
    1. ICP, BMI, surgical repair, and CSF diversion in patients presenting with spontaneous CSF otorrhea. Vivas EX, Mccall A, Raz Y, Fernandez-Miranda JC, Gardner P, Hirsch BE. Otol Neurotol. 2014;35:344–347. - PubMed
    1. Management of cerebrospinal fluid leakage after microvascular decompression surgery: clinical strategy. Lee HS, Cho KR, Park K, Jeon C. Life (Basel) 2023;13 - PMC - PubMed
    1. Spontaneous cerebrospinal fluid leak repair: a five-year prospective evaluation. Chaaban MR, Illing E, Riley KO, Woodworth BA. Laryngoscope. 2014;124:70–75. - PubMed

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