The role of ICP monitoring in patients with persistent cerebrospinal fluid leak following spinal surgery: a case series

Objective Cerebrospinal fluid-venous fistula is an uncommon cause of spontaneous spinal cerebrospinal fluid leak (SSCSFL). We aim to describe the clinical presentation, imaging evaluation, treatment and outcome of SSCSFL secondary to cerebrospinal fluid-venous fistula. Methods A retrospective review was undertaken of SSCSFL cases secondary to cerebrospinal fluid-venous fistula confirmed radiologically or intraoperatively, seen at our institution from January 1994 to March 2019. Cases with undetermined SSCSFL etiology, alternative etiology or unconfirmed fistula were excluded. Results Forty-four of 156 patients met the inclusion criteria (31 women, 13 men). Mean age of symptom onset was 52.6 years (SD 8.7, range 33–71 years). Headache was the presenting symptom in almost all, typically daily (69%), and most often in occipital/suboccipital regions. Headache character was most commonly pressure (38%), followed by throbbing/pulsing (21.4%). Orthostatic headache worsening occurred in 69% and an even greater percentage of patients (88%) reported Valsalva-induced headache exacerbation or precipitation. Headache occurred in isolation to Valsalva maneuvers in 12%. Of 37 patients with documented cerebrospinal fluid opening pressure, 13% were <6 cmH2O; 84%, 7–20 cmH2O; and one, 25 cmH2O. Fistulas were almost exclusively thoracic (95.5%). Only one patient responded definitively to epidural blood patch (EBP). Forty-two patients underwent surgery. Most improved following surgery; 48.7% were completely headache free and 26.8% had at least 50% improvement. Conclusion In our series, cerebrospinal fluid-venous fistula was associated with a greater occurrence of Valsalva-induced headache exacerbation or precipitation than orthostatic headache and did not respond to EBP. Surgery provided significant improvement. Cerebrospinal fluid-venous fistula should be considered early in the differential diagnosis of Valsalva-induced (“cough”) headache.

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Cerebrospinal Fluid Leak in Cochlear Implantation: Enlarged Cochlear versus Enlarged Vestibular Aqueduct (Common Cavity Excluded)

International Journal of Otolaryngology ◽

10.1155/2016/6591684 ◽

2016 ◽

Vol 2016 ◽

pp. 1-9 ◽

Cited By ~ 6

Author(s):

Giovanni Bianchin ◽

Valeria Polizzi ◽

Patrizia Formigoni ◽

Carmela Russo ◽

Lorenzo Tribi

Keyword(s):

Cerebrospinal Fluid ◽

Cochlear Implant ◽

Cochlear Implantation ◽

Case Series ◽

Cerebrospinal Fluid Leak ◽

Enlarged Vestibular Aqueduct ◽

Cochlear Aqueduct ◽

Vestibular Aqueduct ◽

Risk Predictor ◽

Fluid Leak

Objective. To share our experience of cerebrospinal fluid gusher in cochlear implantation in patients with enlarged cochlear or vestibular aqueduct.Study Design. Case series with comparison and a review of the literature.Methods. A retrospective study was performed.Demographic and radiological results of patients with enlarged cochlear aqueduct or enlarged vestibular aqueduct in 278 consecutive cochlear implant recipients, including children and adults, were evaluated between January 2000 and December 2015.Results. Six patients with enlarged cochlear aqueduct and eight patients with enlarged vestibular aqueduct were identified. Cerebrospinal fluid gusher occurs in five subjects with enlarged cochlear aqueduct and in only one case of enlarged vestibular aqueduct.Conclusion. Based on these findings, enlarged cochlear aqueduct may be the best risk predictor of cerebrospinal fluid gusher at cochleostomy during cochlear implant surgery despite enlarged vestibular aqueduct.

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Commentary: Safety of Early Mobilization in Patients With Intra-Operative Cerebrospinal Fluid Leak in Minimally Invasive Spine Surgery: A Case Series

Operative Neurosurgery ◽

10.1093/ons/opab068 ◽

2021 ◽

Author(s):

Dean Chou

Keyword(s):

Cerebrospinal Fluid ◽

Minimally Invasive ◽

Spine Surgery ◽

Case Series ◽

Early Mobilization ◽

Cerebrospinal Fluid Leak ◽

Minimally Invasive Spine Surgery ◽

Minimally Invasive Spine ◽

Fluid Leak

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Collagen matrix as an inlay in endoscopic skull base reconstruction

The Journal of Laryngology & Otology ◽

10.1017/s0022215117001499 ◽

2017 ◽

Vol 132 (3) ◽

pp. 214-223 ◽

Cited By ~ 4

Author(s):

G M Oakley ◽

J M Christensen ◽

M Winder ◽

B P Jonker ◽

A Davidson ◽

...

Keyword(s):

Cerebrospinal Fluid ◽

Skull Base ◽

Case Series ◽

Cerebrospinal Fluid Leak ◽

Collagen Matrix ◽

Intracranial Bleeding ◽

Skull Base Reconstruction ◽

Delayed Complications ◽

Fluid Leak

AbstractBackground:Multi-layer reconstruction has become standard in endoscopic skull base surgery. The inlay component used can vary among autografts, allografts, xenografts and synthetics, primarily based on surgeon preference. The short- and long-term outcomes of collagen matrix in skull base reconstruction are described.Methods:A case series of patients who underwent endoscopic skull base reconstruction with collagen matrix inlay were assessed. Immediate peri-operative outcomes (cerebrospinal fluid leak, meningitis, ventriculitis, intracranial bleeding, epistaxis, seizures) and delayed complications (delayed healing, meningoencephalocele, prolapse of reconstruction, delayed cerebrospinal fluid leak, ascending meningitis) were examined.Results:Of 120 patients (51.0 ± 17.5 years, 41.7 per cent female), peri-operative complications totalled 12.7 per cent (cerebrospinal fluid leak, 3.3 per cent; meningitis, 3.3 per cent; other intracranial infections, 2.5 per cent; intracranial bleeding, 1.7 per cent; epistaxis, 1.7 per cent; and seizures, 0 per cent). Delayed complications did not occur in any patients.Conclusion:Collagen matrix is an effective inlay material. It provides robust long-term separation between sinus and cranial cavities, and avoids donor site morbidity, but carries additional cost.

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Management of cerebrospinal fluid leak from cervical gunshot wounds with external ventricular drainage: a small case series

Journal of Surgical Case Reports ◽

10.1093/jscr/rjaa484 ◽

2020 ◽

Vol 2020 (12) ◽

Author(s):

Clifford L Crutcher ◽

John M Wilson ◽

Kevin D Morrow ◽

Jessica A Shields ◽

Lindsay M Lasseigne ◽

...

Keyword(s):

Cerebrospinal Fluid ◽

External Ventricular Drain ◽

Treatment Algorithm ◽

Case Series ◽

Cerebrospinal Fluid Leak ◽

Gunshot Wounds ◽

External Ventricular Drainage ◽

Csf Leak ◽

Fluid Leak ◽

Csf Leaks

Abstract Historically, the surgical management of gunshot wounds to the spine has been controversial. Repair of a persistent cerebrospinal fluid (CSF) leak is a generally agreed upon indication. The management of such CSF leaks typically involves lumbar drainage or direct surgical repair. Here, the authors report two cases of CSF diversion with an external ventricular drain (EVD) in patients with cervical gunshot wounds. Both patients had spinal canal obliteration or physiologic myelographic block at or below the level of injury. To the best of the author’s knowledge, these are the first two reports of successful EVD treatment of persistent CSF leaks related cervical gunshot wounds. The authors also propose a CSF treatment algorithm for cervical gunshot wounds that includes EVD.

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