PMID- 31774936
OWN - NLM
STAT- MEDLINE
DCOM- 20201207
LR  - 20210903
IS  - 1531-4995 (Electronic)
IS  - 0023-852X (Print)
IS  - 0023-852X (Linking)
VI  - 130
IP  - 9
DP  - 2020 Sep
TI  - Impact of Obesity and Obstructive Sleep Apnea in Lateral Skull Base Cerebrospinal 
      Fluid Leak Repair.
PG  - 2234-2240
LID - 10.1002/lary.28421 [doi]
AB  - OBJECTIVE: To investigate the prevalence and impact of obstructive sleep apnea 
      (OSA) and obesity in lateral skull base cerebrospinal fluid leak repair (LSBR) of 
      various etiologies. METHODS: Retrospective case review at a tertiary skull base 
      center was conducted of consecutive adults undergoing LSBR via transmastoid, 
      middle cranial fossa, or combined approach between 2013-2018. The following data 
      were collected: demographics, comorbidities, radiology and intraoperative 
      findings, and surgical outcomes including complications and need for revision 
      surgery or shunt placement. Patients with incomplete data or leaks following 
      skull base surgery, trauma or chronic ear disease were excluded. RESULTS: 
      Ninety-four patients (67.4% female, mean age 53.5 +/- 12.9 years) underwent repair 
      for spontaneous (sCSFL, 44%) and other etiology (nsCSFL) leaks. nsCSFL served as 
      a comparison group consisting of leaks status-post lateral skull base surgery, 
      temporal bone fractures, and chronic ear disease. Class III obesity (P = .02), 
      OSA (P = .03), and imaging findings of empty sella (OR = 3.32, P = .02), and 
      skull base thinning including contralateral tegmen thinning (31%, OR = 4.3, P 
      = .02), arachnoid granulations (26%, OR = 4.35, P = .02), and superior canal 
      dehiscence (15.8%, OR = 8.57, P = .04) were more common in sCSFL. Four patients 
      (4.2%) required surgical revision for recurrence, and another four (4.2%) 
      resolved with shunting. Evidence of elevated intracranial hypertension was 
      present in nine patients with sCSF leaks and was predictive of need for revision 
      or shunt procedures (P < .01). CONCLUSION: Obesity, OSA, and imaging consistent 
      with elevated intracranial pressures were more common among patients with sCSFL. 
      Elevated intracranial pressure predicted outcomes following multilayer repair of 
      spontaneous CSF leaks LEVEL OF EVIDENCE: 4 Laryngoscope, 130:2234-2240, 2020.
CI  - (c) 2019 The American Laryngological, Rhinological and Otological Society, Inc.
FAU - Yancey, Kristen L
AU  - Yancey KL
AUID- ORCID: 0000-0003-1561-4649
AD  - Department of Otolaryngology-Head and Neck Surgery, Vanderbilt University, 
      Nashville, Tennessee, U.S.A.
FAU - Manzoor, Nauman F
AU  - Manzoor NF
AD  - Department of Otolaryngology-Head and Neck Surgery, Vanderbilt University, 
      Nashville, Tennessee, U.S.A.
FAU - Kelly, Patrick D
AU  - Kelly PD
AD  - Department of Neurosurgery, Vanderbilt University, Nashville, Tennessee, U.S.A.
FAU - Yawn, Robert J
AU  - Yawn RJ
AD  - Department of Otolaryngology-Head and Neck Surgery, Vanderbilt University, 
      Nashville, Tennessee, U.S.A.
FAU - O'Malley, Matthew
AU  - O'Malley M
AD  - Department of Otolaryngology-Head and Neck Surgery, Vanderbilt University, 
      Nashville, Tennessee, U.S.A.
FAU - Rivas, Alejandro
AU  - Rivas A
AD  - Department of Otolaryngology-Head and Neck Surgery, Vanderbilt University, 
      Nashville, Tennessee, U.S.A.
FAU - Haynes, David S
AU  - Haynes DS
AD  - Department of Otolaryngology-Head and Neck Surgery, Vanderbilt University, 
      Nashville, Tennessee, U.S.A.
FAU - Bennett, Marc L
AU  - Bennett ML
AD  - Department of Otolaryngology-Head and Neck Surgery, Vanderbilt University, 
      Nashville, Tennessee, U.S.A.
LA  - eng
GR  - T32 CA106183/CA/NCI NIH HHS/United States
PT  - Journal Article
PT  - Research Support, N.I.H., Extramural
DEP - 20191127
PL  - United States
TA  - Laryngoscope
JT  - The Laryngoscope
JID - 8607378
SB  - IM
MH  - Adult
MH  - Aged
MH  - Cerebrospinal Fluid Leak/*etiology/surgery
MH  - Female
MH  - Humans
MH  - Intracranial Hypertension/complications/*epidemiology/surgery
MH  - Male
MH  - Middle Aged
MH  - Neurosurgical Procedures/*statistics & numerical data
MH  - Obesity/complications/*epidemiology/surgery
MH  - Prevalence
MH  - Retrospective Studies
MH  - Skull Base/surgery
MH  - Sleep Apnea, Obstructive/complications/*epidemiology/surgery
MH  - Treatment Outcome
PMC - PMC8054035
MID - NIHMS1689864
OTO - NOTNLM
OT  - Lateral skull base encephalocele
OT  - hypertension, obstructive sleep apnea
OT  - intracranial
OT  - spontaneous cerebrospinal leak
EDAT- 2019/11/28 06:00
MHDA- 2020/12/15 06:00
PMCR- 2021/09/01
CRDT- 2019/11/28 06:00
PHST- 2019/06/09 00:00 [received]
PHST- 2019/10/24 00:00 [revised]
PHST- 2019/10/30 00:00 [accepted]
PHST- 2019/11/28 06:00 [pubmed]
PHST- 2020/12/15 06:00 [medline]
PHST- 2019/11/28 06:00 [entrez]
PHST- 2021/09/01 00:00 [pmc-release]
AID - 10.1002/lary.28421 [doi]
PST - ppublish
SO  - Laryngoscope. 2020 Sep;130(9):2234-2240. doi: 10.1002/lary.28421. Epub 2019 Nov 
      27.