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

A cerebral spinal fluid (CSF) leak from the anterior skull base is a challenging neurosurgical issue that requires prompt recognition and treatment. Options for treatment include medical and surgical repair. A systematic review was performed screening for both retrospective and prospective clinical studies evaluating the efficacy of acetazolamide in the event of CSF leaks of the anterior skull base.  We initially screened a total of 149 studies for inclusion, and 25 of them met the inclusion criteria. We included four studies on iatrogenic CSF leaks caused by surgery of the anterior cranial fossa, three studies on traumatic CSF leaks, and 18 studies on spontaneous CSF leaks caused by idiopathic intracranial hypertension (IIH). In the event of an iatrogenic CSF leak, 68 patients had undergone an endoscopic endonasal approach. CSF diversion and high-volume lumbar puncture were used frequently with adjunct acetazolamide administration. In the event of trauma, 187 patients were evaluated across the three included studies. Acetazolamide treatment was used as a single approach and effectively controlled CSF leaks. For spontaneous CSF leaks, acetazolamide is frequently used to increase the efficacy of surgical repair. Of the 431 patients, 327 received temporary CSF diversion in addition to acetazolamide. Surgical repair was the primary treatment in 277 patients. Acetazolamide should be considered as a treatment option in patients with CSF leak secondary to surgery of the anterior cranial fossa, trauma, and idiopathic causes.