Dural Venous Sinus Narrowing in Patients with Spontaneous Anterior Skull Base CSF Leak

September 11, 2023

MRI of the skull baseAlthough there is a suggested link between idiopathic intracranial hypertension (IIH) and spontaneous cerebrospinal fluid (sCSF) leak, as well as between IIH and dural venous sinus (DVS) narrowing, the link between DVS narrowing and sCSF leak is poorly understood. Researchers in the Department of Otorhinolaryngology at McGovern Medical School at UTHealth Houston performed a retrospective review of patients with sCSF leak, with the aim of determining the prevalence of DVS narrowing in patients with sCSF leak. The investigators presented their results at the September meeting of the American Academy of Otolaryngology-Head and Neck Surgery (AAO-HNS), which offers an opportunity for residents to present their work at the national level.

“We compared rates of dural venous sinus narrowing in 25 patients with those in the general population based on the available literature,” says William C. Yao, MD, associate professor and director of the residency program in the Department of Otorhinolaryngology at the medical school. “Most patients were women with a mean age of 52 years, and 80% (20 patients) were found to have DVS narrowing, compared to 40% in the general population. Of these 20 patients, 12 (60%) had a degree of narrowing greater than 50%. In patients with sCSF leaks, there was a significantly higher proportion with DVS narrowing compared to the general population.”

Preoperative imaging was independently reviewed by two neuroradiologists to evaluate for DVS narrowing. Available literature was used to estimate the prevalence of DVS narrowing in the general population for comparison.

“Other researchers have linked DVS narrowing and sCSF leak independently to IHH, and have explored the relationship between DVS narrowing and sCSF leak,” Dr. Yao says. “Based on our results, we affirm that there is an association between sCSF leak and DVS narrowing. While our study has limitations – its low power, retrospective nature, and lack of internal controls – there appears to be DVS narrowing in the vast majority of patients with sCSF leaks. Because DVS stenosis may be an underdiagnosed etiology of intracranial hypertension, we believe that preoperative radiological evaluation of DVS using MR venography may be useful in patients with sCSF leaks.”

Karim Asi, MD, a fourth-year otorhinolaryngology resident, presented the results at the AAO-HNS meeting, and the manuscript has been submitted for publication.

AAO-HNS Presentation, September 2022: Dural Venous Sinus Narrowing in Patients with Spontaneous Anterior Skull Base Cerebrospinal Fluid Leak. Karim W. Asi, MD; Brian H. Cameron, MD; Jeffrey P. Radabaugh, MD; Martin J. Citardi, MD; Amber U. Luong, MD, PhD, William C. Yao, MD. University of Texas Health Science Center at Houston (UTHealth), Baptist Medical Center Jacksonville.

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