{
  "abstract": "Introduction Idiopathic intracranial hypertension (IIH) is characterized by chronically elevated intracranial pressure (ICP) and classically presents with papilledema, headache, and visual disturbances. In a subset of patients, IIH may present with spontaneous cerebrospinal fluid (CSF) leak. Data guiding optimal treatment strategies for these patients remain limited.Methods We conducted a retrospective single-center study of patients treated for pharmacologically refractory IIH with venous sinus stenting (VSS) or ventriculoperitoneal shunting (VPS) between January 2021 and December 2024. Baseline characteristics, clinical presentation, radiologic and pressure measurements, CSF leak history, treatment strategies, and outcomes were compared between patients with and without spontaneous CSF leaks.Results Among 152 patients with surgically treated IIH, 20 patients (13%) had a history of spontaneous CSF leak, predominantly involving the nasal skull base (65%). Patients with CSF leaks were older (median 51 vs 37 years, p < 0.001) and less likely to present with papilledema (25% vs 67%; p < 0.001) or vision disturbances (45% vs 77%; p = 0.002). Preoperative lumbar puncture opening pressures were similar between groups (median 33 vs 33 cmH 2O; p > 0.99). Eighteen patients (90%) underwent successful skull-base repair prior to or in conjunction with IIH treatment. Two patients (13.3%) had active CSF leaks at the time of IIH intervention, both of which resolved following IIH-directed therapy. No CSF leak recurrences were observed after combined repair and IIH treatment. Clinical outcomes-including headache, tinnitus, and vision improvement-were comparable between patients with and without CSF leaks, as was the need for salvage therapy (p ≥ 0.05).Conclusions Spontaneous CSF leaks occur in approximately 13% of patients with refractory IIH and does not constitute a prognostic marker of posttreatment IIH outcomes. Combined management with skull-base repair and IIH-directed therapy is effective in preventing leak recurrence.Disclosures V. El-Hajj: None. M. Rizzuto: None.",
  "authors": [
    {
      "affiliations": [
        "Department of Neurosurgery, Thomas Jefferson University Hospital, Philadelphia, PA"
      ],
      "name": "V El-Hajj"
    },
    {
      "affiliations": [
        "Department of Neurosurgery, Thomas Jefferson University Hospital, Philadelphia, PA"
      ],
      "name": "B Musmar"
    },
    {
      "affiliations": [
        "Department of Neurosurgery, Thomas Jefferson University Hospital, Philadelphia, PA"
      ],
      "name": "J Roy"
    },
    {
      "affiliations": [
        "Department of Neurosurgery, Thomas Jefferson University Hospital, Philadelphia, PA"
      ],
      "name": "M Rizzuto"
    },
    {
      "affiliations": [
        "Department of Neurosurgery, Thomas Jefferson University Hospital, Philadelphia, PA"
      ],
      "name": "S Tjoumakaris"
    },
    {
      "affiliations": [
        "Department of Neurosurgery, Thomas Jefferson University Hospital, Philadelphia, PA"
      ],
      "name": "P Jabbour"
    },
    {
      "affiliations": [
        "Department of Neurosurgery, Thomas Jefferson University Hospital, Philadelphia, PA"
      ],
      "name": "M Gooch"
    }
  ],
  "title": "E-221 Management and outcomes of idiopathic intracranial hypertension with concurrent spontaneous cerebrospinal fluid leak: a retrospective cohort study",
  "uid": "5d9e2773-8bf5-53cc-a618-35fee677c500"
}