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J Neurol Surg B Skull Base
DOI: 10.1055/a-2678-8331
Original Article

Reduction of Cerebrospinal Fluid Leaks in Idiopathic Intracranial Hypertension with Glucagon-like Peptide-1 Receptor Agonist Use

Adam S. Vesole 
1   Department of Otolaryngology–Head and Neck Surgery, University of Cincinnati College of Medicine, Cincinnati, Ohio, United States
,
Steven A. Gordon
1   Department of Otolaryngology–Head and Neck Surgery, University of Cincinnati College of Medicine, Cincinnati, Ohio, United States
,
Ahmad R. Sedaghat
1   Department of Otolaryngology–Head and Neck Surgery, University of Cincinnati College of Medicine, Cincinnati, Ohio, United States
,
Katie M. Phillips
1   Department of Otolaryngology–Head and Neck Surgery, University of Cincinnati College of Medicine, Cincinnati, Ohio, United States
,
Jonathan Forbes
2   Department of Neurosurgery, University of Cincinnati College of Medicine, Cincinnati, Ohio, United States
,
Norberto Andaluz
2   Department of Neurosurgery, University of Cincinnati College of Medicine, Cincinnati, Ohio, United States
,
Daniel Q. Sun
1   Department of Otolaryngology–Head and Neck Surgery, University of Cincinnati College of Medicine, Cincinnati, Ohio, United States
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Abstract

Objectives

Elevated intracranial pressure (ICP) secondary to idiopathic intracranial hypertension (IIH) is a recognized risk factor for anterior and lateral skull base cerebrospinal fluid (CSF) leaks. A recent randomized controlled trial (Mitchell et al) demonstrated a significant reduction of ICP in IIH with the use glucagon-like peptide-1 (GLP-1) receptor agonists. This retrospective population study aims to evaluate the role of GLP-1 agonists in reducing CSF leaks.

Design

Retrospective cohort database study.

Setting

A collaborative global database (TriNetX) sourced from electronic medical records from 99 large healthcare organizations across the world.

Participants

Adults (≥18 years old) with a diagnosis of IIH, stratified into groups based on the presence or absence of concurrent GLP-1 agonist use.

Main Outcome Measures

The rate of spontaneous cranial CSF leak and the rate of anterior/lateral skull base CSF leak repair between GLP-1 users versus non-users over 3 years.

Results

Compared with IIH patients not taking GLP-1 agonists (n = 11,825), IIH patients on GLP-1 agonists (n = 11,825) were 24% less likely to develop a spontaneous cranial CSF leak (OR 0.76, 95% CI, 0.61–0.94) and 72% less likely to undergo skull base CSF leak repair (OR 0.28, 95% CI, 0.15–0.51).

Conclusions

GLP-1 agonist use in IIH patients is associated with a lower incidence of spontaneous cranial CSF leaks and a decreased rate of undergoing anterior and/or lateral skull base CSF leak repairs. These promising findings suggest that GLP-1 agonists may be an effective adjuvant therapeutic agent in preventing recurrence following CSF leak repair in IIH patients.

Keywords

idiopathic intracranial hypertension - CSF leak - GLP-1 agonist - lateral skull base - anterior skull base - CSF leak repair


Publication History

Received: 08 April 2025

Accepted: 06 August 2025

Accepted Manuscript online:
08 August 2025

Article published online:
14 August 2025

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