Analysing the effect of early acetazolamide administration on patients with a high risk of permanent cerebrospinal fluid leakage.
AbstractIn this study, we examined the role of early acetazolamide administration in reducing the risk of cerebrospinal fluid (CSF) leakage in patients with a high risk of permanent CSF leakage. In a randomised clinical trial, 57 patients with a high risk of permanent CSF leakage (rhinorrhea, otorrhea, pneumatocele or imaging-based evidence of severe skull-base fracture) were analysed. In the experimental group, acetazolamide, at 25 mg/kg/day, was started in the first 48 hours after admission. In the control group, acetazolamide was administered after the first 48 hours at the same dose administered to the patients in the experimental group. The following factors were compared between the two groups: duration of CSF leakage, duration of hospital stay, incidence of meningitis, need for surgical intervention and need for lumbar puncture (LP) and lumbar drainage (LD). All of the patients in the experimental group stopped having CSF leakage less than 14 days after the first day of admission, but 6 out of 21 patients (22%) in the control group continued having CSF leakage after 14 days of admission, which was a significant difference (P=0.01). This study showed that early acetazolamide administration can prevent CSF leakage in patients with a high risk of permanent CSF leak.
Brandt MT, Jenkins WS, Fattahi TT, Haug RH. Cerebrospinal Fluid: Implications in Oral and Maxillofacial Surgery. J Oral Maxillofac Surg 2002;60:1049-56.
Mokri, B. Spontaneous Cerebrospinal Fluid Leaks: From Intracranial Hypotension to Cerebrospinal Fluid Hypovolemia-Evolution of a Concept. Mayo Clin Proc 1999;74(11): 1113-23
Buchanan R, Brant A, Marshall L. Traumatic Cerebrospinal Fluid Fistulas. In: H. Richard Winn, editor. Neurological Surgery. Saunders; 5th edition, 2003; p.5265-70
Friedman JA, Ebersold MJ, Quast LM. Persistent posttraumatic cerenbrospinal fluid leakage. Neurosurg Focus 2000; 9:1.
Choi D, Spann R. Traumatic cerebrospinal fluid leakage: risk factors and the use of prophylactic antibiotics. Brit J Neurosurge 1996; 10: Issue. 6: 571-576
Welch KC. CSF Rhinorrhea: eMedicine 2006. Retrieved from: http://emedicine.medscape.com/article/861126- overview.
Hanson MB. CSF Otorrhea: eMedicine 2006. Retrieved from: http://emedicine.medscape.com/article/883160- overview
Aldrete JA, Ghaly RF. Propanolol and Acetazolamide in Patients with Postlaminectomy Pseudomeningocele. Am Soci Anesth 2003; 99:1031.
Chalaupka FD. Therapeutic effectiveness of acetazolamide in hindbrain hernia headache. Neurol Sci 2000;21:117-9.
Lasisi AK, Kodiya MA, Udoh DO. Spontaneous closure of traumatic CSF otorrhea following conservative management. African J Health Sci 2006;13(3-4):78-80.
Panagiotakopoulou A, Skouras G, Skouras A. CSF Rhinorrhea: The Case for Conservative Treatment with the Use of Acetazolamide. Proceedings of the International Congress of Rhinology-Otology & Skull Base Surgery. 31 Aug– 3 Sep 2006, Athens, Greece: Skull Base 2006; 16 - A064.
Brodie H, Thompson TC. Management of complications from 840 temporal bone fractures. Am J Otol 1997;18:188-97.
McGuirt WF, Stool SE. Cerebrospinal fluid fistula: the identification and management in pediatric temporal bone fractures. Laryngoscope 1995; 105: 359-64.
Park JI, Strelzow VV and Friedman WH. Current management of cerebrospinal fluid rhinorrhoea. Laryngoscope 1983; 93: 1294-1300
Stankiewicz, JA. Cerebrospinal fluid fistula and endoscopic sinus surgery. Laryngoscope 1991;101(30):250-6.