The management of massive pneumocephalus and cerebrospinal fluid rhinorrhoea as a consequence of biopsy in a patient with inverted papilloma

1998 ◽  
Vol 112 (7) ◽  
pp. 657-659 ◽  
Author(s):  
U. S. Kale ◽  
S. G. Raje ◽  
R. G. Wight
Keyword(s):  
Cerebrospinal Fluid ◽  
Nasal Polyps ◽  
Inverted Papilloma ◽  
Successful Outcome ◽  
Csf Leak ◽  
Lateral Rhinotomy ◽  
Endoscopic Repair ◽  
Cerebrospinal Fluid Rhinorrhoea ◽  
Csf Rhinorrhoea

AbstractNasal polypectomy is a common ENT operation. Cerebrospinal fluid (CSF) rhinorrhoea and pneumocephalus are rare complications. We present a patient who developed both these complications after biopsy of nasal polyps which subsequently proved to be an inverted papilloma. He had a defect in the ethmoid roof, which was repaired.Whilst endoscopic repair of CSF leak is increasing in popularity, in this patient because of his pathology and difficulty of access a more traditional lateral rhinotomy approach was made with a successful outcome. An overview of the management of these complications is presented.

Use of protein electrophoresis in the diagnosis of cerebrospinal fluid rhinorrhoea

1992 ◽  
Vol 106 (6) ◽  
pp. 504-506 ◽  
Author(s):  
M. J. Porter ◽  
G. B. Brookes ◽  
A. Z. J. Zeman ◽  
G. Keir
Keyword(s):  
Cerebrospinal Fluid ◽  
Diagnostic Accuracy ◽  
Tau Protein ◽  
Electrophoretic Analysis ◽  
Protein Electrophoresis ◽  
Csf Leak ◽  
Cerebrospinal Fluid Rhinorrhoea ◽  
Csf Rhinorrhoea ◽  
Nasal Secretions

AbstractThe diagnosis of CSF rhinorrhoea on clinical grounds alone can be difficult. We describe how the use of noninvasive electrophoretic analysis of nasal secretions for tau protein (asialotransferrin) helped in the management of cases where the existence of a CSF leak was in doubt. Patients were thus saved unnecessary invasive investigations or surgery. A modification of the method of analysis, which improves diagnostic accuracy, is described.

scholarly journals Endoscopic cerebrospinal fluid leak repair: how we do it

2019 ◽  
Vol 5 (4) ◽  
pp. 965
Author(s):  
Kalpesh Patel ◽  
Abhishek Gugliani ◽  
Rajesh Vishwakarma
Keyword(s):  
Cerebrospinal Fluid ◽  
Cerebrospinal Fluid Leak ◽  
Subsequent Treatment ◽  
Csf Leak ◽  
Open Approach ◽  
Endoscopic Repair ◽  
Civil Hospital ◽  
Medical College ◽  
Endoscopic Method ◽  
Csf Rhinorrhoea

<p class="abstract"><strong>Background:</strong> Cerebrospinal fluid (CSF) rhinorrhoea is characterized by a defect in the barriers which separate the subarachnoid space from sinonasal tract resulting in the leakage of watery fluid from the nose. Management of CSF rhinorrhoea is by both conservative and/or surgical approach. Transnasal endoscopic method has become the preferred surgical method for the repair of CSF leak because of less complication as compared to the open approach. To evaluate the results of patients who underwent endoscopic repair of CSF rhinorrhoea over a period of 5 years at BJ Medical College, Civil Hospital, Ahmedabad.</p><p class="abstract"><strong>Methods:</strong> 118 patients were included in this retrospective study who underwent CSF leak repair by nasal endoscopy over a period of 5 years between 2011-2016 in the department of ENT at BJ Medical College, Civil Hospital, Ahmedabad. As per review of the records, these patients were diagnosed with CSF leak on the basis of their history, clinical examination, and radiological investigations. Materials used for the repair were fat, fascia lata, fibrin sealant, and/or vascular flap.  </p><p class="abstract"><strong>Results:</strong> Primary surgery was successful in 110 (93%) of cases. In 8 (7%) cases, there was a recurrence of leak which was managed by either conservative management (5 cases, 4%) or by re-exploration (3 cases, 3%).</p><p class="abstract"><strong>Conclusions:</strong> Transnasal endoscope is an important tool for the evaluation and subsequent treatment of CSF rhinorrhoea. Endoscopic repair of CSF rhinorrhoea is safe, effective, has a low complication rate and has almost completely replaced the open technique.</p>

The endoscopic treatment of cerebrospinal fluid rhinorrhoea: the Nottingham experience

1997 ◽  
Vol 111 (2) ◽  
pp. 125-128 ◽  
Author(s):  
R. G. M. Hughes ◽  
N. S. Jones ◽  
I. J. A. Robertson
Keyword(s):  
Cerebrospinal Fluid ◽  
Subsequent Treatment ◽  
Endoscopic Approach ◽  
Csf Leak ◽  
Endoscopic Repair ◽  
Closure Rate ◽  
Endoscopic Techniques ◽  
Csf Rhinorrhoea ◽  
Skull Base Defect

AbstractThe conventional neurosurgical management of cerebrospinal fluid (CSF) rhinorrhoea has been by intracranial access. Otorhinolaryngologists have undertaken extracranial approaches where access has been possible, and more recently an endoscopic approach has been advocated. We report 17 patients with confirmed CSF rhinorrhoea treated with endoscopic techniques between 1993 and 1996. Follow-up ranged from four to 32 months and showed an overall closure rate of 16 out of 17 patients with no complications. No patient undergoing primary endoscopic repair developed anosmia. The use of fluorescein helped localize the site of the CSF leak in four patients in whom the computed tomography (CT) scan had not identified the site of the defect.We conclude that the endoscope is a valuable tool in the evaluation and subsequent treatment of CSF rhinorrhoea. Where the skull base defect is accessible to the endoscope, we propose that an endoscopic approach should be considered as the preferred method.

Bilateral cerebrospinal fluid rhinorrhoea

2000 ◽  
Vol 114 (2) ◽  
pp. 137-138 ◽  
Author(s):  
James D. Ramsden ◽  
Rogan Corbridge ◽  
Grant Bates
Keyword(s):  
Cerebrospinal Fluid ◽  
Surgical Treatment ◽  
Surgical Approach ◽  
Subarachnoid Space ◽  
Complication Rates ◽  
Endoscopic Repair ◽  
Csf Fistula ◽  
Cerebrospinal Fluid Rhinorrhoea ◽  
Csf Rhinorrhoea ◽  
Csf Leaks

Cerebrospinal fluid (CSF) rhinorrhoea is leakage of fluid from the subarachnoid space to the frontal, sphenoidal or ethmoidal sinuses, and may occur spontaneously. The authors present the first reported case of bilateral spontaneous CSF rhinorrhoea. Bony defects on both sides of the cribriform plate were identified using endoscopic and radiological techniques, and the CSF fistula was closed endoscopically. The aetiology, diagnosis and contemporary surgical treatment of spontaneous CSF leaks is discussed. Endoscopic repair was successful in this case, and in view of the high success and low reported complication rates this surgical approach should be considered for treatment of spontaneous CSF rhinorrhoea.

scholarly journals Cerebrospinal Fluid Rhinorrhoea in Pituitary Tumours

1980 ◽  
Vol 73 (4) ◽  
pp. 244-254 ◽  
Author(s):  
I E Cole ◽  
Malcolm Keene
Keyword(s):  
Cerebrospinal Fluid ◽  
Pituitary Tumours ◽  
Pituitary Fossa ◽  
Muscle Graft ◽  
Cerebrospinal Fluid Rhinorrhoea ◽  
Csf Rhinorrhoea

Three cases of CSF rhinorrhoea due to pituitary tumours are reported and the literature reviewed. The treatment of choice appears to be trans-sphenoidal exploration of the pituitary fossa with insertion of a free muscle graft followed by radiotherapy. The probability of the tumour being a prolactin-secreting adenoma is discussed.

Endoscopic Repair of Cerebrospinal Fluid Rhinorrhea: Learning from Our Failures

2001 ◽  
Vol 15 (5) ◽  
pp. 333-342 ◽  
Author(s):  
Paolo Castelnuovo ◽  
Silvia Mauri ◽  
Davide Locatelli ◽  
Enzo Emanuelli ◽  
Giovanni Delù ◽  
...  
Keyword(s):  
Cerebrospinal Fluid ◽  
Success Rate ◽  
Csf Leak ◽  
Graft Material ◽  
Literature Analysis ◽  
Endoscopic Repair ◽  
Common Procedure ◽  
Csf Rhinorrhea ◽  
Cerebrospinal Fluid Rhinorrhea

Endoscopic repair of cerebrospinal fluid (CSF) rhinorrhea is becoming a common procedure. The purpose of this study was to perform a literature analysis centering cases of treatment failure and to review our 31 cases with a 1-year minimum follow-up. An extensive search of the literature was conducted, which focused on success rate, follow-up, diagnostic techniques, graft material used, failure rate, and comments on failures. A retrospective analysis of our 31 patients was carried out, and all cases were treated with the endoscopic approach with a 1-year minimum follow-up. From the literature analysis, the median success rate at the first endoscopic attempt is 90%. Our success rate was 87.1%. Failures were analyzed. A unique protocol for CSF leak diagnosis does not exist; we suggest our diagnostic algorithm. Graft material used depends on the authors’ experience, and based on this review of cases to date, did not significantly influence the success rate. The analysis of cases of failure shows that the majority of authors omit details. More research is needed to improve prevention of failures.

Tension pneumocephalus with cerebrospinal fluid rhinorrhoea in a post craniotomy patient

2010 ◽  
Vol 9 (1) ◽  
pp. 13-14
Author(s):  
Nicholas H Smallwood ◽  
◽  
Sreenivasan Shiva ◽  
Keyword(s):  
Cerebrospinal Fluid ◽  
Clinical Features ◽  
Frontal Sinus ◽  
Surgical Intervention ◽  
Csf Leak ◽  
Dural Tear ◽  
Tension Pneumocephalus ◽  
Neurological Signs ◽  
Important Complication ◽  
Csf Rhinorrhoea

Tension pneumocephalus is an uncommon but important complication of neurosurgery, often requiring urgent surgical intervention. It should be considered in any patient presenting with neurological symptoms after recent craniotomy, particularly if they also have clinical features consistent with cerebrospinal fluid (CSF) leak. We describe a patient who presented four weeks post-craniotomy with fluctuating neurological signs and CSF rhinorrhoea, who made a full recovery following repair of a frontal sinus defect and dural tear.

scholarly journals A OBSERVATIONAL STUDY OF ENDOSCOPIC REPAIR OF CSF RHINORRHOEA

2020 ◽  
pp. 74-76
Author(s):  
Bijoy Krishna Bhadra ◽  
Soumen Biswas ◽  
Debarshi Jana
Keyword(s):  
Success Rate ◽  
Middle Turbinate ◽  
Csf Leak ◽  
Endoscopic Repair ◽  
Radiological Investigation ◽  
Nasal Endoscope ◽  
Primary Surgery ◽  
Second Surgery ◽  
Csf Rhinorrhoea ◽  
Graft Success

Background: Intrathecal fluorescein may be used to visualize CSF fistulas using a nasal endoscope. This allows the examiner to directly visualize the size of the defect, its location, and its rate of flow. The first repair of CSF leak was performed by Dandy in 1926 using a frontal craniotomy. This technique had a 60-80% success rate and was the gold standard for decades. In 1964Vrabec and Hallberg described the endonasal approach of CSF leak repair. AIMS: This study aims to establish the success rate of endoscopic surgical repair of CSF rhinorrhoca. MATERIALS AND METHODS: The study was conducted in Department of ENT IPGMER and SSKM Hospital. During the study period of 18 months, 30 patients have been admitted in our department with CSF leak (most of them were referred from neurosurgery). RESULTS: Fat and fascia lata and temporalis fascia were used to repair CSF leak in 24 patients. Bath plug technique was applied for 3 patients. Repair with vascularised flap such as Hadad flap or middle turbinate graft were used in case of 3 patients. CSF rhinorrhoea repair was successful in 28 out of 30(94%) patients after primary surgery whereas recurrence occurred in 2(6%) cases. Among them 1 patient underwent second surgery which achieved definitive closure of the leak. But one case lost follow up and did not come for second surgery. Interval between surgery and recurrence was varied and so were the causes. CONCLUSION: CSF rhinorrhoea cases can be repaired by an endoscopic approach with a high success rate. Radiological investigation of PNS and brain are equally important for selection of cases for endoscopic repair. Spontaneous leak must be checked cautiously to exclude features of raised ICT. Relapse occurs mainly for failure to delineate actual site or sites of leak and inadequate size or faulty placement of graft. Success depends not only on surgical skill but also on baseline intracranial tension, cause & site of leak and postoperative care.

Bilateral, spontaneous cerebrospinal fluid rhinorrhoea: endoscopic, uninasal, trans-septal approach for simultaneous closure

2011 ◽  
Vol 125 (11) ◽  
pp. 1185-1188
Author(s):  
M Kurien ◽  
G A Mathew ◽  
S L Abraham ◽  
A Irodi
Keyword(s):  
Cerebrospinal Fluid ◽  
Case Report ◽  
English Language ◽  
Past History ◽  
Cerebrospinal Fluid Leakage ◽  
Endoscopic Repair ◽  
Recent Onset ◽  
Cerebrospinal Fluid Rhinorrhoea ◽  
Fluid Leakage ◽  
History Of

AbstractBackground:Bilateral, spontaneous cerebrospinal fluid rhinorrhoea is extremely rare, with only one previous case report (this patient developed contralateral cerebrospinal fluid leakage four years after successful endoscopic repair). We present the first English-language report of simultaneous, bilateral, spontaneous cerebrospinal fluid rhinorrhoea.Objective:To recommend a simple alternative endoscopic technique for simultaneous closure of bilateral, spontaneous cerebrospinal fluid rhinorrhoea.Case report:A 47-year-old woman presented with recent onset of bilateral, spontaneous cerebrospinal fluid rhinorrhoea, a recent history suggestive of meningitis, and a past history of pneumococcal meningitis. Bony defects on both sides of the cribriform plate were closed endoscopically in the same anaesthetic session, via a uninasal, trans-septal approach, enabling both leakage sites to be sealed simultaneously.Conclusion:In cases of bilateral, spontaneous cerebrospinal fluid rhinorrhoea, uninasal, trans-septal endoscopic repair is a simple and effective technique for simultaneous closure of cerebrospinal fluid leakage.

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