Body Mass Index and Imaging Abnormalities in Spontaneous Cerebrospinal Fluid Leaks of the Temporal Bone

Abstract

Objectives:

Determine if (1) increased body mass index (BMI) is associated with spontaneous cerebrospinal fluid leak (SCSFL) of the temporal bone when compared with NSCSFL; (2) if body mass index (BMI) is a prognostic factor in the management of SCSFL; (3) if aberrant arachnoid granulations and empty sella are associated with SCSFL when compared to NSCSFL.

Methods:

Retrospective chart review of patients from 2002 to 2013 of all patients treated for CSFL.

Results:

Eighteen patients were treated for SCSFL and 17 for NSCSFL between 2002 and 2013. The mean BMI of the SCSFL group was 32.86 (median 33.53). The mean BMI of the NSCSFL group was 28.54 (median 29) (P = .0683). The average BMI of patients requiring revision surgery was 37.88 compared to patients who only required a single intervention 30.35 (P = .012). 100% of patients with SCSFL had ectopic arachnoid granulations identified on CT temporal bone while none of the patients with NSCSFL had these (P < .001). 66% (8/12) of patients with SCSFL had empty sella on MRI compared to 16 % (2/12) of those with NSCSFL (P = .04).

Conclusions:

Patients with SCSFL of the temporal bone have an elevated BMI when compared with NSCSFL. The presence of arachnoid granulations and empty sella on diagnostic imaging is associated with SCSFL when compared to NSCSFL. Patients with SCSFL requiring multiple interventions demonstrated a higher BMI than those treated successfully with a single intervention, indicating that this may be a poor prognostic factor.