{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,17]],"date-time":"2026-09-17T10:37:42Z","timestamp":1789641462140,"version":"4.0.0"},"reference-count":35,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"4","license":[{"start":{"date-parts":[[2022,10,27]],"date-time":"2022-10-27T00:00:00Z","timestamp":1666828800000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":[],"abstract":"<jats:sec>\n            <jats:title>Background:<\/jats:title>\n            <jats:p>Rates of spontaneous cerebrospinal fluid leak (sCSF) repairs have increased in recent decades in line with increases in obesity rates.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Objectives:<\/jats:title>\n            <jats:p>To determine if the national rate of sCSF leak has continued to rise in recent years and to identify associated risk factors utilizing a comprehensive national database comprising most academic medical centers.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Methods:<\/jats:title>\n            <jats:p>A retrospective review from 2009 to 2018 was performed using the Vizient Clinical Database (CDB) of 105 leading academic medical centers in the United States. Patients who underwent CSF leak repair in the CDB database using <jats:italic toggle=\"yes\">ICD-9<\/jats:italic> and <jats:italic toggle=\"yes\">ICD-10<\/jats:italic> diagnostic and procedure codes. Patients with epidural hematomas over the same time frame were used as a control. National rates of craniotomy for sCSF leak repair each quarter were assessed and sCSF leak patient characteristics (age, gender, obesity, hypertension, diabetes) were calculated.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Results:<\/jats:title>\n            <jats:p>The rate of craniotomy for all sCSF leak repairs increased by 10.2% annually from 2009 to 2015 (<jats:italic toggle=\"yes\">P<\/jats:italic> &lt; 0.0001). There was no statistically significant change in the rate of epidural hematomas over the same period. The rate of lateral sCSF leak repair increased on average by 10.4% annually from 2009 (218 cases\/year) to 2018 (457 cases\/year) (<jats:italic toggle=\"yes\">P<\/jats:italic> &lt; 0.0001). A statistically significant increase was observed across all regions of the United States (<jats:italic toggle=\"yes\">P<\/jats:italic> \u2264 0.005). sCSF leak patients had an average (standard deviation) age of 55.0 (13.2) years and 67.2% were female. Obesity was the only demographic factors that increased significantly over time. Likely due to comorbid factors, Black patients comprise a disproportionately large percentage of lateral sCSF leak repair patients.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Conclusions:<\/jats:title>\n            <jats:p>The rate of craniotomy for spontaneous CSF leaks continues to rise by approximately 10% annually.<\/jats:p>\n          <\/jats:sec>","DOI":"10.1097\/ono.0000000000000021","type":"journal-article","created":{"date-parts":[[2023,2,3]],"date-time":"2023-02-03T00:46:17Z","timestamp":1675385177000},"page":"e021","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":12,"title":["Trends in Spontaneous Cerebrospinal Fluid Leak Repairs in the United States, 2009\u20132018"],"prefix":"10.1097","volume":"2","author":[{"given":"Douglas J.","family":"Totten","sequence":"first","affiliation":[{"name":"Department of Otolaryngology\u2014Head and Neck Surgery, Indiana University, School of Medicine, Indianapolis, IN"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elizabeth","family":"Schueth","sequence":"additional","affiliation":[{"name":"Indiana University School of Medicine, Indianapolis, IN"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mohamad Z.","family":"Saltagi","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology\u2014Head and Neck Surgery, Indiana University, School of Medicine, Indianapolis, IN"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cyrus","family":"Rabbani","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology\u2014Head and Neck Surgery, Indiana University, School of Medicine, Indianapolis, IN"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alyssa Hartsell","family":"Harris","sequence":"additional","affiliation":[{"name":"Vizient Inc., Chicago, IL"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dani","family":"Tressman","sequence":"additional","affiliation":[{"name":"Vizient Inc., Chicago, IL"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Samuel F.","family":"Hohmann","sequence":"additional","affiliation":[{"name":"Vizient Inc., Chicago, IL"},{"name":"Department of Health Systems Management, Rush University, Chicago, IL"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rick F.","family":"Nelson","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology\u2014Head and Neck Surgery, Indiana University, School of Medicine, Indianapolis, IN"},{"name":"Indiana University School of Medicine, Indianapolis, IN"},{"name":"Department of Neurosurgery, Indiana University, School of Medicine, Indianapolis, IN."}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","published-online":{"date-parts":[[2022,12]]},"reference":[{"key":"R1-20241014","doi-asserted-by":"crossref","first-page":"845","DOI":"10.1016\/j.otc.2011.06.018","article-title":"Spontaneous CSF leaks.","volume":"44","author":"Wang","year":"2011","journal-title":"Otolaryngol Clin North Am"},{"key":"R2-20241014","doi-asserted-by":"crossref","first-page":"241","DOI":"10.1136\/jnnp.27.3.241","article-title":"Primary spontaneous cerebrospinal fluid rhinorrhoea.","volume":"27","author":"O\u2019Connell","year":"1964","journal-title":"J Neurol Neurosurg Psychiatry"},{"key":"R3-20241014","first-page":"337","article-title":"A retrospective analysis of spontaneous sphenoid sinus fistula: MR and CT findings.","volume":"21","author":"Shetty","year":"2000","journal-title":"AJNR Am J Neuroradiol"},{"key":"R4-20241014","doi-asserted-by":"crossref","first-page":"902","DOI":"10.1177\/000348940711601206","article-title":"Risk of meningitis with cerebrospinal fluid rhinorrhea.","volume":"116","author":"Daudia","year":"2007","journal-title":"Ann Otol Rhinol Laryngol"},{"key":"R5-20241014","doi-asserted-by":"crossref","first-page":"215","DOI":"10.1002\/lio2.75","article-title":"Surgical repair of spontaneous cerebrospinal fluid (CSF) leaks: a systematic review.","volume":"2","author":"Lobo","year":"2017","journal-title":"Laryngoscope Investig Otolaryngol"},{"key":"R6-20241014","doi-asserted-by":"crossref","first-page":"2170","DOI":"10.1002\/lary.27208","article-title":"Surgical management of spontaneous cerebrospinal fistulas and encephaloceles of the temporal bone.","volume":"128","author":"Kutz","year":"2018","journal-title":"Laryngoscope"},{"key":"R7-20241014","doi-asserted-by":"crossref","first-page":"476","DOI":"10.1097\/MAO.0000000000000535","article-title":"The rising incidence of spontaneous cerebrospinal fluid leaks in the United States and the association with obesity and obstructive sleep apnea.","volume":"36","author":"Nelson","year":"2015","journal-title":"Otol Neurotol"},{"key":"R8-20241014","doi-asserted-by":"crossref","first-page":"1422","DOI":"10.1167\/iovs.11-8220","article-title":"Body mass index has a linear relationship with cerebrospinal fluid pressure.","volume":"53","author":"Berdahl","year":"2012","journal-title":"Invest Ophthalmol Vis Sci"},{"key":"R9-20241014","doi-asserted-by":"crossref","first-page":"97","DOI":"10.1016\/j.amjoto.2018.09.018","article-title":"Management of spontaneous temporal bone cerebrospinal fluid leak: a 30-year experience.","volume":"40","author":"Cheng","year":"2019","journal-title":"Am J Otolaryngol"},{"key":"R10-20241014","doi-asserted-by":"crossref","first-page":"275","DOI":"10.1097\/MLG.0b013e31815937a6","article-title":"Relationship between obesity, obstructive sleep apnea, and spontaneous cerebrospinal fluid otorrhea.","volume":"118","author":"LeVay","year":"2008","journal-title":"Laryngoscope"},{"key":"R11-20241014","doi-asserted-by":"crossref","first-page":"1412","DOI":"10.1097\/MAO.0b013e318268d350","article-title":"The role of obesity in spontaneous temporal bone encephaloceles and CSF leak.","volume":"33","author":"Stucken","year":"2012","journal-title":"Otol Neurotol"},{"key":"R12-20241014","doi-asserted-by":"crossref","first-page":"1723","DOI":"10.1001\/jama.288.14.1723","article-title":"Prevalence and trends in obesity among US adults, 1999-2000.","volume":"288","author":"Flegal","year":"2002","journal-title":"JAMA"},{"key":"R13-20241014","doi-asserted-by":"crossref","first-page":"2284","DOI":"10.1001\/jama.2016.6458","article-title":"Trends in obesity among adults in the United States, 2005 to 2014.","volume":"315","author":"Flegal","year":"2016","journal-title":"JAMA"},{"key":"R16-20241014","doi-asserted-by":"crossref","first-page":"571","DOI":"10.1016\/j.gtc.2016.07.012","article-title":"Obesity epidemiology trends by race\/ethnicity, gender, and education: National Health Interview Survey, 1997\u20132012.","volume":"45","author":"Arroyo-Johnson","year":"2017","journal-title":"Gastroenterol Clin North Am"},{"key":"R17-20241014","article-title":"Racial and ethnic disparities in adult obesity in the United States: CDC\u2019s tracking to inform state and local action.","volume":"16:E46","author":"Peterson","year":"2019","journal-title":"Prev Chronic Dis"},{"key":"R18-20241014","doi-asserted-by":"crossref","first-page":"e619","DOI":"10.1097\/MAO.0000000000002249","article-title":"Association of Intracranial Hypertension With Calvarial and Skull Base Thinning.","volume":"40","author":"Rabbani","year":"2019","journal-title":"Otol Neurotol"},{"key":"R19-20241014","doi-asserted-by":"crossref","first-page":"513","DOI":"10.1001\/jamaoto.2018.0347","article-title":"Association of obstructive sleep apnea with calvarial and skull base thinning.","volume":"144","author":"Rabbani","year":"2018","journal-title":"JAMA Otolaryngol Head Neck Surg"},{"key":"R20-20241014","doi-asserted-by":"crossref","first-page":"481","DOI":"10.1097\/MAO.0000000000000552","article-title":"Calvarium thinning in patients with spontaneous cerebrospinal fluid leak.","volume":"36","author":"Nelson","year":"2015","journal-title":"Otol Neurotol"},{"key":"R21-20241014","doi-asserted-by":"crossref","first-page":"2175","DOI":"10.1007\/s00405-017-4455-5","article-title":"Spontaneous cerebrospinal fluid leaks in the anterior skull base secondary to idiopathic intracranial hypertension.","volume":"274","author":"Martinez-Capoccioni","year":"2017","journal-title":"Eur Arch Otorhinolaryngol"},{"key":"R22-20241014","doi-asserted-by":"crossref","first-page":"e475","DOI":"10.1097\/MAO.0000000000001805","article-title":"Prevalence of obstructive sleep apnea (OSA) in spontaneous cerebrospinal fluid (CSF) leaks: a prospective cohort study.","volume":"39","author":"Rabbani","year":"2018","journal-title":"Otol Neurotol"},{"key":"R23-20241014","doi-asserted-by":"crossref","first-page":"733","DOI":"10.1001\/jamaoto.2015.1128","article-title":"Association between obstructive sleep apnea and spontaneous cerebrospinal fluid leaks: a systematic review and meta-analysis.","volume":"141","author":"Bakhsheshian","year":"2015","journal-title":"JAMA Otolaryngol Head Neck Surg"},{"key":"R24-20241014","first-page":"1","article-title":"Prevalence of obesity and severe obesity among adults: United States, 2017\u20132018.","volume":"360","author":"Hales","year":"2020","journal-title":"NCHS Data Brief"},{"key":"R25-20241014","doi-asserted-by":"crossref","first-page":"940","DOI":"10.1097\/MAO.0b013e3181e8f36c","article-title":"New considerations in the cause of spontaneous cerebrospinal fluid otorrhea.","volume":"31","author":"Goddard","year":"2010","journal-title":"Otol Neurotol"},{"key":"R26-20241014","doi-asserted-by":"crossref","first-page":"70","DOI":"10.1002\/lary.24160","article-title":"Spontaneous cerebrospinal fluid leak repair: a five-year prospective evaluation.","volume":"124","author":"Chaaban","year":"2014","journal-title":"Laryngoscope"},{"key":"R27-20241014","doi-asserted-by":"crossref","first-page":"344","DOI":"10.1097\/MAO.0b013e3182a473cf","article-title":"ICP, BMI, surgical repair, and CSF diversion in patients presenting with spontaneous CSF otorrhea.","volume":"35","author":"Vivas","year":"2014","journal-title":"Otol Neurotol"},{"key":"R28-20241014","doi-asserted-by":"crossref","first-page":"861","DOI":"10.1212\/01.wnl.0000304746.92913.dc","article-title":"Racial differences in idiopathic intracranial hypertension.","volume":"70","author":"Bruce","year":"2008","journal-title":"Neurology"},{"key":"R29-20241014","doi-asserted-by":"crossref","first-page":"303","DOI":"10.5664\/jcsm.2572","article-title":"The influence of race on the severity of sleep disordered breathing.","volume":"9","author":"Pranathiageswaran","year":"2013","journal-title":"J Clin Sleep Med"},{"key":"R30-20241014","doi-asserted-by":"crossref","first-page":"178","DOI":"10.1111\/j.1526-4610.2008.01240.x","article-title":"The relationship between idiopathic intracranial hypertension and obesity.","volume":"49","author":"Hannerz","year":"2009","journal-title":"Headache"},{"key":"R31-20241014","doi-asserted-by":"crossref","first-page":"197","DOI":"10.1097\/WNO.0000000000000448","article-title":"Obesity and weight loss in idiopathic intracranial hypertension: a narrative review.","volume":"37","author":"Subramaniam","year":"2017","journal-title":"J Neuroophthalmol"},{"key":"R32-20241014","doi-asserted-by":"crossref","first-page":"279","DOI":"10.1378\/chest.95.2.279","article-title":"Intracranial pressure and obstructive sleep apnea.","volume":"95","author":"Jennum","year":"1989","journal-title":"Chest"},{"key":"R33-20241014","doi-asserted-by":"crossref","first-page":"214","DOI":"10.1016\/0013-4694(85)90033-1","article-title":"Marked episodic elevation of cerebrospinal fluid pressure during nocturnal sleep in patients with sleep apnea hypersomnia syndrome.","volume":"60","author":"Sugita","year":"1985","journal-title":"Electroencephalogr Clin Neurophysiol"},{"key":"R34-20241014","doi-asserted-by":"crossref","first-page":"487","DOI":"10.1097\/WNO.0000000000000761","article-title":"Do most patients with a spontaneous cerebrospinal fluid leak have idiopathic intracranial hypertension?","volume":"39","author":"Bidot","year":"2019","journal-title":"J Neuroophthalmol"},{"key":"R35-20241014","doi-asserted-by":"crossref","first-page":"1006","DOI":"10.1093\/aje\/kws342","article-title":"Increased prevalence of sleep-disordered breathing in adults.","volume":"177","author":"Peppard","year":"2013","journal-title":"Am J Epidemiol"},{"key":"R36-20241014","doi-asserted-by":"crossref","first-page":"1266","DOI":"10.1111\/j.1468-1331.2011.03372.x","article-title":"The incidence and prevalence of idiopathic intracranial hypertension in Sheffield, UK.","volume":"18","author":"Raoof","year":"2011","journal-title":"Eur J Neurol"},{"key":"R37-20241014","doi-asserted-by":"crossref","first-page":"133","DOI":"10.1001\/jama.2018.6823","article-title":"Transition to the ICD-10 in the United States: an emerging data chasm.","volume":"320","author":"Khera","year":"2018","journal-title":"JAMA"}],"container-title":["Otology &amp; Neurotology Open"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/journals.lww.com\/10.1097\/ONO.0000000000000021","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,10,15]],"date-time":"2024-10-15T00:08:28Z","timestamp":1728950908000},"score":1,"resource":{"primary":{"URL":"https:\/\/journals.lww.com\/10.1097\/ONO.0000000000000021"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,10,27]]},"references-count":35,"journal-issue":{"issue":"4","published-online":{"date-parts":[[2022]]}},"URL":"https:\/\/doi.org\/10.1097\/ono.0000000000000021","relation":{},"ISSN":["2766-3604"],"issn-type":[{"value":"2766-3604","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,10,27]]}}}