A Comparative Analysis of Anterior & Lateral Cranial Base CSF Leaks

Introduction The optimal strategy for management of Idiopathic Intracranial Hypertension (IIH) in anterior and lateral cranial base meningoencephaloceles remains debated. The purpose of this study is to present a comparison of the surgical management of anterior and lateral cranial base meningoencephalocele and a treatment algorithm for the diagnosis and management of IIH in this patient population. Methods Retrospective study of 109 patients who underwent anterior or lateral CSF leak repair at TJU from 2004-2020. Epic & RedCap were utilized to record data. Patient demographics, presenting symptoms, imaging, Beta-2 Transferring testing, surgery, repair, and post-op data were collected. Two-sided Chi-squared tests and Independent t-test were performed via SPSS Statistics 26. Results 49 anterior cranial base (ACB) and 60 lateral cranial base (LCB) defects were included. Anterior cohort had significantly more women (N=77, 85.7%, p=0.02). Anterior cohort presented with significantly higher multiple leak sites (24.5% vs 15.0%, p=0.036). Six patients, 3 in each cohort, none of whom received Ventriculoperitoneal shunts (VPS) developed recurrence. VPS were placed for long-term CSF diversion in 23 ACB cases (46.9%) and 10 LCB cases (16.7%), (p\u3c0.01). Discussion ACB cases had a higher incidence of females, multiple site leaks, and more likely to undergo VPS placement. No patients developed recurrence after placement of a VPS. Long-term CSF diversion via VPS, in addition to surgical repair, should be considered in patients with elevated intracranial pressure and other high-risk factors to prevent recurrence of CSF leaks

Evaluation of Asthma Control in Patients with and without Sinonasal Polyps following Treatment with Biologic Agents

Background: The effects of biologics on severe asthmatics with chronic rhinosinusitis with sinonasal polyposis (CRSwNP) have not been well established. This study evaluates overall control of asthma in patients with and without sinonasal polyps following initiation of biologics therapy. Methods: Retrospective review of patients with asthma treated with a biologic agent (benralizumab, omalizumab, dupilumab, mepolizumab) and CRSwNP. Charts were assessed for ACT scores at time of biologic enrollment and at 4-7 months. Results: 82 patients met inclusion criteria; 42 (52.5%) patients with asthma and 40 (47.5%) with concurrent sinonasal polyps. The average ACT score for the non-polyp cohort was 13.16 + 4.12 at baseline, and 16.45 + 4.79 at long term follow-up; 15.85 + 3.13 and 20.19 + 1.68 in patients with polyps at both time points respectively. Patients with polyps had better control of their asthma at baseline (p=0.001), however both cohorts had overall poor baseline asthma control (ACT\u3c19). Patients with polyps continued to have significantly better overall control of their asthma at long term follow up (p\u3c0.001) and, on average, were able to achieve sustained asthma control (mean ACT = 20.19), after initiation of biologic therapy. Conclusions: Patients with and without sinonasal polyps who begin biologic therapy are shown to have significant improvements in their ACT score at follow-up. In addition, patients with polyps are shown to have significantly better control of their asthma while on biologics than patients with no polyps. Comorbid CRSwNP may predict response to biologic therapy in those with severe asthma (SA)