Acetazolamide use in postoperative CSF leak prevention: A literature review

Background

Acetazolamide, a carbonic anhydrase inhibitor and commonly utilized diuretic, has been found to decrease cerebrospinal fluid (CSF) production, leading to its use in the prevention of postoperative CSF leaks. Despite its widespread use, the efficacy and optimal protocols for acetazolamide in this context remain poorly defined. This systematic review aims to elucidate the role of acetazolamide in preventing postoperative and traumatic CSF leaks.

Methods

A systematic review was performed in Covidence adhering to PRISMA Guidelines. A search of PubMed, SCOPUS, and CINAHL for literature published through July 2023 identified 215 unique publications related to acetazolamide use in preventing postoperative CSF leaks. Full texts were independently screened by two authors, with discrepancies resolved by third reviewer. 15 publications were selected and categorized into themes including postoperative CSF leak prevention, trauma management, dosage optimization, and adverse effects.

Results

Of the fifteen articles, twelve focused on the role of acetazolamide in preventing postoperative CSF leaks, highlighting its effectiveness in reducing leak rates following neurosurgical and otolaryngological procedures. Themes discussed in the remaining six articles included acetazolamide's role in managing intracranial hypertension in trauma patients, optimal dosing strategies, and the spectrum of side effects ranging from mild to severe.

Conclusion

Acetazolamide shows promise in the prevention of postoperative CSF leaks and in certain trauma contexts. However, further studies should establish standardized protocols and optimize dosing regimens. Future research should also focus on long-term outcomes and the management of adverse effects to fully elucidate the benefits and limitations of acetazolamide in these clinical settings.