Trends in Spontaneous Cerebrospinal Fluid Leak Repairs in the United States, 2009-2018

Douglas J Totten; Elizabeth Schueth; Mohamad Z Saltagi; Cyrus Rabbani; Alyssa Hartsell Harris; Dani Tressman; Samuel F Hohmann; Rick F Nelson

doi:10.1097/ONO.0000000000000021

Trends in Spontaneous Cerebrospinal Fluid Leak Repairs in the United States, 2009-2018

Otol Neurotol Open. 2022 Oct 27;2(4):e021. doi: 10.1097/ONO.0000000000000021. eCollection 2022 Dec.

Authors

Douglas J Totten¹, Elizabeth Schueth², Mohamad Z Saltagi¹, Cyrus Rabbani¹, Alyssa Hartsell Harris³, Dani Tressman³, Samuel F Hohmann^{3

4}, Rick F Nelson^{1

2

5}

Affiliations

¹ Department of Otolaryngology-Head and Neck Surgery, Indiana University, School of Medicine, Indianapolis, IN.
² Indiana University School of Medicine, Indianapolis, IN.
³ Vizient Inc., Chicago, IL.
⁴ Department of Health Systems Management, Rush University, Chicago, IL.
⁵ Department of Neurosurgery, Indiana University, School of Medicine, Indianapolis, IN.

Abstract

Background: Rates of spontaneous cerebrospinal fluid leak (sCSF) repairs have increased in recent decades in line with increases in obesity rates.

Objectives: To determine if the national rate of sCSF leak has continued to rise in recent years and to identify associated risk factors utilizing a comprehensive national database comprising most academic medical centers.

Methods: A retrospective review from 2009 to 2018 was performed using the Vizient Clinical Database (CDB) of 105 leading academic medical centers in the United States. Patients who underwent CSF leak repair in the CDB database using ICD-9 and ICD-10 diagnostic and procedure codes. Patients with epidural hematomas over the same time frame were used as a control. National rates of craniotomy for sCSF leak repair each quarter were assessed and sCSF leak patient characteristics (age, gender, obesity, hypertension, diabetes) were calculated.

Results: The rate of craniotomy for all sCSF leak repairs increased by 10.2% annually from 2009 to 2015 (P < 0.0001). There was no statistically significant change in the rate of epidural hematomas over the same period. The rate of lateral sCSF leak repair increased on average by 10.4% annually from 2009 (218 cases/year) to 2018 (457 cases/year) (P < 0.0001). A statistically significant increase was observed across all regions of the United States (P ≤ 0.005). sCSF leak patients had an average (standard deviation) age of 55.0 (13.2) years and 67.2% were female. Obesity was the only demographic factors that increased significantly over time. Likely due to comorbid factors, Black patients comprise a disproportionately large percentage of lateral sCSF leak repair patients.

Conclusions: The rate of craniotomy for spontaneous CSF leaks continues to rise by approximately 10% annually.

Keywords: CSF leak; Cerebrospinal fluid; Craniotomy; Spontaneous.