Calvarium Thinning in Patients with Spontaneous Cerebrospinal Fluid Leaks of the Anterior Skull Base. (23rd September 2020)

• Record Type: Journal Article
• Authors: Sharma, Dhruv; Tucker, Brady J.; Millay, David S.; Rubel, Kolin E.; Saltagi, Mohamad; Nelson, Rick F.; Illing, Elisa A.; Ting, Jonathan Y.
• Is Part Of: Laryngoscope. Volume 131:Number 6(2021)
• Page Start: 1271
• Page End: 1276
• Publication Date: 2020-09-23
• Subjects: Anterior skull base -- computed tomography -- CSF rhinorrhea -- endoscopic skull base surgery -- skull base repair; Otolaryngology -- Periodicals; 617.51005
• DOI: 10.1002/lary.29130
• Languages: English
• ISSNs: 0023-852X

Abstract

Abstract : Objectives/Hypothesis: Patients with spontaneous cerebrospinal fluid leaks (sCSF‐L) of the temporal bone have isolated calvarial and skull base thinning that is independent of obesity. This study determines if anterior skull base (ASB) sCSF‐L patients also have calvarial thinning. Study Design: Retrospective Cohort Study. Methods: This was a retrospective cohort study of ASB sCSF‐L patients compared to nonobese (body mass index [BMI] < 30 kg/m 2 ) and obese (BMI ≥ 30) control groups. Twenty‐one patients in the ASB sCSF‐L group and 25 patients in each control group were included. Calvarium and extracranial zygoma thicknesses were measured bilaterally with blinded, standardized, volumetric analysis. Results: ASB sCSF‐L patients had a mean (SD) age of 50.43 (10.19) years, an average (SD) BMI of 38.81 (8.92) kg/m 2, and most were female (85.71%). The calvarium in patients with ASB sCSF‐L was significantly thinner than the nonobese (2.55 mm [0.77] vs. 2.97 [0.67] mm; P = .006; 95% confidence intervals [CI], 0.12–0.30; Cohen d, 0.58) and obese control groups (2.55 [0.77] vs. 2.92 [0.76] mm; P = .02; 95% CI, 0.05–0.34; Cohen d, 0.66). The calvarium thickness of the nonobese patients was not significantly different from the obese patient controls (2.97 [0.67] vs. 2.92 [0.76] mm, P = .9). The extracranial zygoma was not significantly different among the groups (analysis of variance, P = .33). Conclusions: ASB sCSF‐L patients have isolated calvarial thinning that is independent of obesity. Like lateral skull base sCSF‐L patients, these data suggest that the additional obesity‐associated intracranial process contributes to skull thinning. Level of Evidence: 4 Laryngoscope, 131:1271–1276, 2021