Spinal epidermoid tumor after external lumbar drainage positioning for CSF leak: a case report

2022 ◽  
Author(s):  
Cristiano Parisi ◽  
Giuseppe Pulcrano ◽  
Giovanna Faraca ◽  
Enzo Colarusso ◽  
Silvio Sarubbo
Keyword(s):  
Case Report ◽  
Csf Leak ◽  
Lumbar Drainage ◽  
Epidermoid Tumor ◽  
External Lumbar Drainage

scholarly journals Sinking Skin Flap Syndrome and Paradoxical Herniation Provoked by a Malfunction of External Lumbar Drainage and CSF Leak

2019 ◽  
Vol 19 (3) ◽  
pp. 103-110
Author(s):  
M Hanko ◽  
P Snopko ◽  
R Opsenak ◽  
M Benco ◽  
R Richterova ◽  
...  
Keyword(s):  
Cerebrospinal Fluid ◽  
Decompressive Craniectomy ◽  
Skin Flap ◽  
Drainage System ◽  
Cerebrospinal Fluid Leak ◽  
Csf Leak ◽  
Lumbar Drainage ◽  
Cerebral Herniation ◽  
Fluid Leak ◽  
External Lumbar Drainage

Abstract The sinking skin flap syndrome represents a less-frequent complication in patients after a decompressive craniectomy. It is defined as a neurological deterioration accompanied by a flat or concave deformity of the craniectomy-related skin flap. The underlying brain parenchyma is distorted correspondingly with its blood flow and metabolism being impaired and cerebrospinal fluid hydrodynamics being disturbed, thus causing cerebral dysfunction and neurological symptomatology. The most important options for reversal of this syndrome include Trendelenburg position, maintaining of the cerebrospinal fluid balance, and cranioplasty as a definite solution. We present a patient who underwent a decompressive craniectomy complicated by a cerebrospinal fluid leak in the operative wound treated by means of an external lumbar drainage. Subsequently he developed the sinking skin flap syndrome and a paradoxical cerebral herniation after the drainage system malfunction with a massive cerebrospinal fluid leak at the site of the lumbar drain insertion parallel to the drain itself. His symptoms were, however, successfully alleviated by a positional change, rehydration, and interruption of the lumbar drainage. This illustrational case suggests that clinicians should be aware that patients after decompressive craniectomy may develop a sinking skin flap syndrome as it may either represent an acute risk of a paradoxical brain herniation or complicate the further postoperative care if developed in a chronic way.

A review of external lumbar drainage for the management of intracranial hypertension in traumatic brain injury

2021 ◽  
Author(s):  
Elizabeth E Ginalis ◽  
Laura L Fernández ◽  
Juan P Ávila ◽  
Sarita Aristizabal ◽  
Andres M Rubiano
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Intracranial Hypertension ◽  
Lumbar Drainage ◽  
External Lumbar Drainage

A Single Layer Synthetic Dural Substitute Inlay is an Effective Sellar Reconstruction Technique in Endoscopic Transsphenoidal Pituitary Surgery

2020 ◽  
Author(s):  
Mark B. Chaskes ◽  
Tawfiq Khoury ◽  
Chandala Chitguppi ◽  
Pascal Lavergne ◽  
Gurston G. Nyquist ◽  
...  
Keyword(s):  
Pituitary Adenoma ◽  
Tertiary Care ◽  
Single Layer ◽  
Csf Leak ◽  
Reconstruction Technique ◽  
Potential Cost ◽  
Lumbar Drainage ◽  
Dural Substitute ◽  
Sellar Reconstruction ◽  
Csf Leaks

Abstract Objectives A variety of endonasal sellar repair techniques have been described; many are complex, multilayered, and carry potential morbidity. We propose an effective, technically simple single-layer repair for select sellar defects, including those with an intraoperative cerebrospinal fluid (CSF) leak. Our technique utilizes only a synthetic dural substitute inlay and dural sealant glue without packing or lumbar drainage. Design This is a retrospective review-based study. Setting This study was conducted at tertiary care center. Participants Patients who underwent endoscopic transsphenoidal surgery for pituitary adenoma and sellar reconstruction with the aforementioned inlay technique. Patients were selected for this technique if they had an identified intraoperative CSF leak, a patulous diaphragm (expanded and thinned diaphragma sella), or a comorbidity excluding them from a simpler onlay only reconstruction. Outcome Measures Postoperative CSF leak and sinonasal morbidity included in the study Results A total of 409 subjects were identified; 368 were initial resections. Gross total resection of the pituitary adenoma was achieved in 356 (87.0%) cases. Average tumor size was 2.6 ± 1.1 cm. Average tumor volume was 10.8 ± 12.1 cm3. There were 135 intraoperative CSF leaks and 196 patulous diaphragms. There were five postoperative CSF leaks (1.2%), all of which occurred in the first half of our series. Pre- and postoperative sino-nasal outcomes test-22 scores were 19.2 ± 18.2 and 18.8 ± 21.3 (p = 0.492), respectively. Conclusion A synthetic dural substitute inlay and dural sealant glue is an excellent single-layer repair for sellar defects, even those with an intraoperative CSF leak. This technique is highly effective in preventing postoperative CSF leaks and does not utilize packing or lumbar drainage. It also avoids the potential cost and morbidity associated with more complex and multilayered closures.

scholarly journals Diploic Epidermoid Tumor Associated with Subperiosteal Hematoma —Case Report—

1994 ◽  
Vol 34 (7) ◽  
pp. 444-447
Author(s):  
Satoshi HIROSE ◽  
Sadahiro SHIMADA ◽  
Ryuhei KITAI ◽  
Hirokazu KAWANO ◽  
Toshihiko KUBOTA
Keyword(s):  
Case Report ◽  
Epidermoid Tumor

scholarly journals Bilateral temporal bone fractures: a case report

2017 ◽  
Vol 4 (1) ◽  
pp. 271
Author(s):  
Kiran Natarajan ◽  
Koka Madhav ◽  
A. V. Saraswathi ◽  
Mohan Kameswaran
Keyword(s):  
Hearing Loss ◽  
Case Report ◽  
Facial Nerve ◽  
Temporal Bone ◽  
Facial Paralysis ◽  
Bone Fractures ◽  
Clinical Manifestations ◽  
Csf Leak ◽  
The Right ◽  
Temporal Bones

<p>Bilateral temporal bone fractures are rare; accounting for 9% to 20% of cases of temporal bone fractures. Clinical manifestations include hearing loss, facial paralysis, CSF otorhinorrhea and dizziness. This is a case report of a patient who presented with bilateral temporal bone fractures. This is a report of a 23-yr-old male who sustained bilateral temporal bone fractures and presented 18 days later with complaints of watery discharge from left ear and nose, bilateral profound hearing loss and facial weakness on the right side. Pure tone audiometry revealed bilateral profound sensori-neural hearing loss. CT temporal bones &amp; MRI scans of brain were done to assess the extent of injuries. The patient underwent left CSF otorrhea repair, as the CSF leak was active and not responding to conservative management. One week later, the patient underwent right facial nerve decompression. The patient could not afford a cochlear implant (CI) in the right ear at the same sitting, however, implantation was advised as soon as possible because of the risk of cochlear ossification. The transcochlear approach was used to seal the CSF leak from the oval and round windows on the left side. The facial nerve was decompressed on the right side. The House-Brackmann grade improved from Grade V to grade III at last follow-up. Patients with bilateral temporal bone fractures require prompt assessment and management to decrease the risk of complications such as meningitis, permanent facial paralysis or hearing loss. </p>

scholarly journals Incidental frontal lobe mixed density epidermoid tumor in a patient of head injury: A rare case report

2015 ◽  
Vol 10 (4) ◽  
pp. 338
Author(s):  
Pankaj Gupta ◽  
Radheyshyam Mittal ◽  
Ashok Gandhi ◽  
Achal Sharma ◽  
Sapna Gandhi
Keyword(s):  
Case Report ◽  
Head Injury ◽  
Frontal Lobe ◽  
Rare Case ◽  
Epidermoid Tumor ◽  
Rare Case Report

scholarly journals Subdural Hemorrhage after Scoliosis and Detethering of Cord Surgery

2018 ◽  
Vol 2018 ◽  
pp. 1-3
Author(s):  
Rohan Bhimani ◽  
Fardeen Bhimani ◽  
Preeti Singh
Keyword(s):  
Case Report ◽  
Idiopathic Scoliosis ◽  
Intracranial Hypotension ◽  
Rare Case ◽  
Screw Fixation ◽  
Conus Medullaris ◽  
Csf Leak ◽  
Subdural Hemorrhage ◽  
Pedicular Screw ◽  
Csf Leaks

Introduction. Intracranial hypotension may occur when CSF leaks from the subarachnoid space. Formation of intracranial, subdural, and subarachnoid hemorrhage has been observed after significant CSF leak as seen in lumbar puncture or ventricular shunt placement. However, very few cases, referring to these remote complications following spine surgery, have been described in literature. We present a case of a 10-year-old male child operated for idiopathic scoliosis with low-lying conus medullaris who postoperatively developed subdural hemorrhage. Case Report. A case of a 10-year-old male operated for idiopathic scoliosis with low-lying conus medullaris is presented. To correct this, detethering was done at the L3 level, laminectomy was done from L2 to L3 with pedicular screw fixation from T3 to L2, and bone grafting with right costoplasty was done from the 3rd to the 6th ribs. On the 5th day postoperatively, the patient developed convulsions and drowsiness and recovered subsequently by postoperative day 7. Conclusion. We report a rare case of an acute intracranial subdural hemorrhage caused by intracranial hypotension following scoliosis and detethering of cord surgery. This report highlights the potential morbidity associated with CSF leak occurring after this surgery.

External Lumbar Drainage for Refractory Intracranial Hypertension in Traumatic Brain Injury: A Systematic Review

2021 ◽  
Author(s):  
Andrew Robert Stevens ◽  
Wai Cheong Soon ◽  
Yasir Arafat Chowdhury ◽  
Emma Toman ◽  
Antonio Belli ◽  
...  
Keyword(s):  
Systematic Review ◽  
Intracranial Hypertension ◽  
Medical Therapy ◽  
Data Extraction ◽  
Lumbar Drainage ◽  
Safety Reporting ◽  
Sustained Effect ◽  
Cerebral Herniation ◽  
Adverse Patient Outcome ◽  
External Lumbar Drainage

Abstract BackgroundExternal lumbar drainage remains a controversial therapy for medically refractory intracranial hypertension in patients with acute TBI. This systematic review sought to compile the available evidence for the efficacy and safety of the use of lumbar drains for ICP control. MethodsA systematic review of the literature was performed with the search and data extraction performed by two reviewers independently in duplicate.ResultsNine independent studies were identified enrolling 230 patients, 159 with TBI. Efficacy for ICP control was observed across all studies, with immediate and sustained effect, reducing medical therapy requirements. Lumbar drainage with medical therapy appears effective when used alone and as an adjunct to ventricular drainage. Safety reporting varied in quality. Cerebral herniation (with unclear relationship to lumbar drainage) was observed in 14/230 patients resulting in one incident of morbidity without adverse patient outcome. ConclusionsThe available data is generally poor in quality and volume, but supportive of efficacy of lumbar drainage for ICP control. Few reports of adverse outcome are suggestive of, but are insufficient to confirm, safety of use in the appropriate patient and clinical setting. Further large prospective observational studies are required to generate sufficient support of an acceptable safety profile.

Sign in / Sign up

Export Citation Format

Share Document