Lumbar Puncture Opening Pressure in Spontaneous CSF Otorrhea

Abstract

Objective: Determine the incidence of increased intracranial pressure, measured by lumbar puncture opening pressure, in patients with spontaneous cerebrospinal fluid (CSF) otorrhea.

Method: Retrospective case review at a tertiary care referral center. Patients included underwent repair of spontaneous CSF otorrhea between January 2007 and December 2011. These patients have subsequently undergone postoperative lumbar puncture with measurement of the opening pressure to determine the presence of increased intracranial pressure. The main outcome measure is the lumbar puncture opening pressure.

Results: Nineteen ears in 17 patients underwent surgical repair for spontaneous CSF otorrhea via a transmastoid or middle fossa craniotomy. The average age at the time of repair was 58.9 years, 82.4% of patients were women, and 94.1% of patients were obese (BMI >30). The left ear was more commonly involved in 68.4% of cases. An encephalocele was observed in 63.2% of ears. Elevated opening pressure (greater than 20 cm/H₂O) was noted in 41.2% of patients, and the median opening pressure was 19 cm/H₂O. Of patients with elevated intracranial pressure, 55.6% were treated either medically or surgically to reduce ICP. Two patients underwent placement of ventriculoperitoneal shunts and 3 were treated with acetazolamide.

Conclusion: As has been reported in the literature regarding spontaneous CSF rhinorrhea, elevated intracranial pressure is common in patients with spontaneous CSF otorrhea with 41.2% of patients affected in this series. These patients frequently require intervention in the postoperative setting to reduce ICP.