Efficacy of Acetazolamide for Treatment of Iatrogenic, Traumatic, and Spontaneous Cerebrospinal Fluid Leaks of the Anterior Skull Base: A Systematic Review
2024

Efficacy of Acetazolamide for Treating CSF Leaks

Sample size: 431 publication Evidence: moderate

Author Information

Author(s): Muacevic Alexander, Adler John R, Raub Spencer L, Abecassis Zachary A, Hanks Thomas A, Hiatt Kyly, Jamshidi Aria, Celano Emma, Ferreira Manny, Emerson Sam, Ruzevick Jacob

Primary Institution: University of Washington Medical Center

Hypothesis

What is the efficacy of acetazolamide in treating cerebrospinal fluid leaks of the anterior skull base?

Conclusion

Acetazolamide can be an effective treatment option for cerebrospinal fluid leaks caused by surgery, trauma, and idiopathic conditions.

Supporting Evidence

  • Acetazolamide was used in 431 patients across various studies for treating CSF leaks.
  • 68 patients with iatrogenic leaks had undergone an endoscopic endonasal approach.
  • Acetazolamide treatment effectively controlled CSF leaks in traumatic cases.
  • 327 out of 431 patients received temporary CSF diversion along with acetazolamide.
  • 277 patients underwent surgical repair as the primary treatment.

Takeaway

Acetazolamide is a medicine that can help fix leaks in the fluid around the brain, especially after surgery or injury.

Methodology

A systematic review of 149 studies was conducted, screening for both retrospective and prospective clinical studies evaluating acetazolamide's efficacy in CSF leaks.

Potential Biases

The risk of bias was assessed using the Cochrane Risk of Bias tool and the Newcastle-Ottawa Scale, with many studies showing moderate to low risk.

Limitations

The studies reviewed had significant variability in design, and most were retrospective, which may introduce bias.

Participant Demographics

The review included patients with iatrogenic, traumatic, and spontaneous CSF leaks, with a total of 431 patients across 25 studies.

Digital Object Identifier (DOI)

10.7759/cureus.75214

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