• Pavel Poczos, Miroslav Cihlo, Karel Zadrobílek, Jiří Jandura, Petr Čelakovský, Jaroslav Adamkov, Roman Kostyšyn, and Tomáš Česák.
• Department of Neurosurgery, University Hospital Hradec Králové, Faculty of Medicine in Hradec Králové, Charles University, Hradec Králové, Czechia; Department of Anatomy, Faculty of Medicine in Hradec Králové, Charles University, Hradec Králové, Czechia. Electronic address: poczosp@lfhk.cuni.cz.
• World Neurosurg. 2023 Apr 1; 172: e574e580e574-e580.

ObjectiveTo provide an analysis of patients with spontaneous skull base meningoencephaloceles (MECs) to determine whether definitive surgical treatment requires management of elevated intracranial pressure (ICP).MethodsData of 10 subjects with spontaneous MECs were collected and retrospectively evaluated. Measurement of ICP, prior interventions, treatment with acetazolamide, and characteristics of long-term elevated ICP, among others, were analyzed. Our own indications for cerebrospinal fluid (CSF) diversion and use of postoperative external lumbar drain were analyzed as well.ResultsThe sphenoid region was the most common location of MECs. CSF leak was diagnosed in all subjects. The most common graphical signs of elevated ICP were empty sella and arachnoid pits, both of which were present in 90% of cases. Lumbar puncture with opening pressure measurement was performed in 7 patients. Ventriculoperitoneal shunt insertion was indicated in 4 cases before skull base repair and in 2 cases after skull base repair. Two postoperative CSF leaks were managed with external lumbar drain and subsequent shunt installation.ConclusionsSpontaneous MECs are often associated with CSF leak. ICP assessment should be a standard of care to ensure successful operative repair of MECs. Insertion of a CSF diversion device must be considered where direct or indirect signs of intracranial hypertension are present.Copyright © 2023 Elsevier Inc. All rights reserved.

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