Venous sinus stenting for management of spontaneous skull-base CSF leaks: A systematic review and meta-analysis

Abstract

Background

Idiopathic intracranial hypertension (IIH) is strongly associated with spontaneous skull-base cerebrospinal fluid (CSF) leaks. Venous sinus stenting (VSS) has proven effective for the treatment of IIH. Hence, its role in spontaneous skull-base CSF leaks is being explored actively.

Methods

We performed a systematic literature search across EMBASE, MEDLINE, Scopus, The Cochrane Library, and Google Scholar to identify studies reporting the use of VSS for spontaneous skull-base CSF leaks. Studies with pediatric patients, non-English articles, and nonspontaneous leaks were excluded. Failure of treatment (persistence / recurrence of CSF leak) was regarded as the primary outcome.

Results

Eight studies with 62 patients undergoing VSS for spontaneous skull-base CSF leaks were included. Mean age of the patients was 51.9 years; 87.5% were females. Obesity was highly prevalent, with a mean body mass index of 33.9 kg/m² (4 studies). IIH was noted in 74.6% patients (7 studies). Twenty-six patients (41.9%) underwent VSS alone whereas 36 patients (58.1%) underwent surgical repair + VSS. Seven patients (11.3%) had a failure of treatment. Three failures from one study could not be definitively ascribed to either of the groups. Hence, the estimated failure rate for VSS alone ranged from 18.6% (95% CI [0.02 – 0.46]) to 26.4% (95% CI [0.11 – 0.46]), whereas that for surgical repair + VSS ranged from 5.5% (95% CI [0.00 – 0.16]) to 12.2% (95% CI [0.01 – 0.32]). Furthermore, the estimated rate for resolution of concomitant IIH-related symptoms was 88.7% (95% CI [0.75 – 0.98%]). Majority of the studies did not report any serious complications or mortality related to VSS.

Conclusion

VSS has a potential role in the management of spontaneous skull-base CSF leaks. Its exact indications as a standalone treatment versus as an adjuvant to surgical repair, and the predictors for successful treatment remain to be defined.

Keywords

Venous sinus stenting transverse sinus stenting transverse sinus stenosis spontaneous skull base CSF leak spontaneous CSF leak idiopathic intracranial hypertension intracranial pressure

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