Spontaneous cerebrospinal fluid leaks in the anterior skull base: a surgical challenge

AbstractObjective:This retrospective study aimed to evaluate the effective closure rate for spontaneous cerebrospinal fluid leaks with functional endoscopic sinus surgery and identify patient characteristics that may be associated with a need for additional therapy.Method:A retrospective analysis of patients with spontaneous cerebrospinal fluid leaks was performed. Data on the nature of presentation, patient body mass index, defect location and size, intracranial pressure, clinical follow up, and complications were collected.Results:Twenty-five patients had spontaneous cerebrospinal fluid leaks with evidence of idiopathic intracranial hypertension. The most common sites were the cribriform plate, followed by the ethmoid roof and sphenoid lateral pterygoid recess. All patients underwent endonasal endoscopic surgery to repair the defect. Post-operatively, all patients underwent lumbar drainage and acetazolamide therapy.Conclusion:Spontaneous cerebrospinal fluid leaks represent a surgical challenge because of their high recurrence rates. The most important factor for obtaining a successful repair in these patients is reducing their intracranial pressure through nutritional, medical or surgical means.

Download Full-text

Management of spontaneous cerebrospinal fluid leaks of the sphenoid sinus: our experience

The Journal of Laryngology & Otology ◽

10.1017/s0022215114001698 ◽

2014 ◽

Vol 128 (9) ◽

pp. 797-802 ◽

Cited By ~ 7

Author(s):

G Fyrmpas ◽

I Konstantinidis ◽

P Selviaridis ◽

J Constantinidis

Keyword(s):

Cerebrospinal Fluid ◽

Intracranial Pressure ◽

Sphenoid Sinus ◽

Successful Outcome ◽

Dietary Advice ◽

Elevated Intracranial Pressure ◽

Endoscopic Closure ◽

Cerebrospinal Fluid Leaks ◽

Stable Reconstruction

AbstractBackground:Closure of spontaneous sphenoid sinus cerebrospinal fluid leaks can be challenging because of the relative inaccessibility of the lateral recess and the presence of intracranial hypertension. We present our experience of such cases and highlight factors associated with a successful outcome.Methods:Eleven patients with spontaneous, laboratory confirmed, sphenoid sinus cerebrospinal fluid leaks were included. All patients underwent endoscopic closure by either a three-layer technique or fat obliteration.Results:In all but one patient, the leak was successfully sealed (success rate, 90.9 per cent; mean follow up, 37.1 months). Elevated intracranial pressure was measured in eight patients, two of whom did not exhibit relevant clinical or radiological characteristics. Five patients received diuretics and dietary advice for weight reduction. In one patient with recurrence two weeks after repair, successful revision was performed by additional placement of a ventriculoperitoneal shunt (follow up, 67 months).Conclusion:Long-lasting cerebrospinal fluid fistula sealing in the sphenoid sinus requires stable reconstruction of the defect in three layers or fat obliteration if the anatomy is unfavourable. All patients should be intra- and post-operatively screened for elevated intracranial pressure to identify those who need additional intracranial pressure reduction measures.

Download Full-text

Long-term outcomes of transvaginal mesh surgery for pelvic organ prolapse: a retrospective cohort study

BMC Women s Health ◽

10.1186/s12905-021-01505-z ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Xiaojuan Wang ◽

Yisong Chen ◽

Changdong Hu ◽

Keqin Hua

Keyword(s):

Pelvic Organ Prolapse ◽

Patient Characteristics ◽

Pelvic Organ ◽

Transvaginal Mesh ◽

Recurrence Rates ◽

Kaplan Meier ◽

Mesh Surgery ◽

Patient Global Impression

Abstract Background The objective of this study was to evaluate the overall outcomes and complications of transvaginal mesh (TVM) placement for the management of pelvic organ prolapse (POP) with different meshes with a greater than 10-years of follow-up. Methods We performed a retrospective review of patients with POP who underwent prolapse repair surgery with placement of transvaginal mesh (Prolift kit or self-cut Gynemesh) between January 2005 and December 2010. Baseline of patient characteristics were collected from the patients’ medical records. During follow-up, the anatomical outcomes were evaluated using the POP Quantification system, and the Patient Global Impression of Improvement (PGI-I) was used to assess the response of a condition to therapy. Overall postoperative satisfaction was assessed by the following question: “What is your overall postoperative satisfaction, on a scale from 0 to 10?”. Relapse-free survival was analyzed using Kaplan–Meier curves. Results In total, 134 patients were included. With a median 12-year (range 10–15) follow-up, 52 patients (38.8%) underwent TVM surgery with Prolift, and Gynemesh was used 82 (61.2%). 91% patients felt that POP symptom improved based on the PGI-I scores, and most satisfied after operation. The recurrence rates of anterior, apical and posterior compartment prolapse were 5.2%, 5.2%, and 2.2%, respectively. No significant differences in POP recurrence, mesh-associated complications and urinary incontinence were noted between TVM surgery with Prolift versus Gynemesh. Conclusions Treatment of POP by TVM surgery exhibited long-term effectiveness with acceptable morbidity. The outcomes of the mesh kit were the same as those for self-cutmesh.

Download Full-text

Sinus Surgery in Patients With Previously Repaired Cerebrospinal Fluid Leaks

Yearbook of Otolaryngology-Head and Neck Surgery ◽

10.1016/s1041-892x(09)79388-6 ◽

2009 ◽

Vol 2009 ◽

pp. 250-251

Author(s):

R. Sindwani

Keyword(s):

Cerebrospinal Fluid ◽

Sinus Surgery ◽

Cerebrospinal Fluid Leaks

Download Full-text

Revision Functional Endoscopic Sinus Surgery: Objective and Subjective Surgical Outcomes

American Journal of Rhinology ◽

10.1177/194589240501900404 ◽

2005 ◽

Vol 19 (4) ◽

pp. 344-347 ◽

Cited By ~ 48

Author(s):

K. Christopher McMains ◽

Stilianos E. Kountakis

Keyword(s):

Medical Therapy ◽

Endoscopic Sinus Surgery ◽

Functional Endoscopic Sinus Surgery ◽

Sinus Surgery ◽

Patient Symptom ◽

Before And After ◽

Revision Sinus Surgery ◽

Preoperative Ct ◽

The Mean

Background The aim of this study was to report objective and subjective outcomes after revision sinus surgery (RESS) for chronic rhinosinusitis (CRS). Methods We performed a retrospective analysis of prospectively collected data in 125 patients requiring revision functional endoscopic sinus surgery after failing both maximum medical therapy and prior sinus surgery for CRS. Patients were seen and treated over a 3-year period (1999–2001) in a tertiary rhinology setting. Computed tomography (CT) scans were graded as per Lund-MacKay and patient symptom scores were recorded using the Sinonasal Outcome Test 20 (SNOT-20) instrument. Individual rhinosinusitis symptoms were evaluated on a visual analog scale (0–10) before and after surgery. All patients had a minimum 2-year follow-up. Results The mean number of prior sinus procedures was 1.9 ± 0.1 (range, 1–7) and the mean preoperative CT grade was 13.4 ± 0.7. Patients with asthma and polyposis had higher CT scores than those without these processes. Preoperative mean SNOT-20 and endoscopy scores were 30.7 ± 1.3 and 7.3 ± 0.4, respectively. At the 2-year follow-up, mean SNOT-20 and endoscopy scores improved to 7.7 ± 0.6 and 2.1 ± 0.4, respectively (p < 2.8 X 10-10). At 12-month follow-up, each individual symptom score decreased significantly. Overall, 10 patients failed RESS and required additional surgical intervention for an overall failure rate of 8.0%. All patients who failed RESS had nasal polyposis. Conclusion Revision functional endoscopic sinus surgery benefits patients that fail maximum medical therapy and prior sinus surgery for CRS by objective and subjective measures.

Download Full-text

External frontal sinusotomy and endoscopic repair of cerebrospinal fluid fistula in the posterior wall: preliminary report of a new technique

The Journal of Laryngology & Otology ◽

10.1017/s0022215111001150 ◽

2011 ◽

Vol 125 (8) ◽

pp. 802-806 ◽

Cited By ~ 6

Author(s):

P Thulasi Das ◽

D Balasubramanian

Keyword(s):

Cerebrospinal Fluid ◽

Frontal Sinus ◽

Posterior Wall ◽

Anterior Wall ◽

New Technique ◽

Endoscopic Repair ◽

Tertiary Referral Centre ◽

Cerebrospinal Fluid Leaks ◽

A New Technique

AbstractIntroduction:Cerebrospinal fluid rhinorrhoea is the abnormal leakage of cerebrospinal fluid into the nasal cavity. The posterior wall of the frontal sinus can be the site of such leakage. Traditionally, these leaks were repaired via external osteoplastic or neurosurgical approaches. Despite advances in instrumentation, it is difficult to manage superiorly or laterally placed defects endoscopically. We present a new technique of endoscopic repair of frontal sinus posterior wall defects, via access holes drilled in the anterior wall of the frontal sinus.Study design:Preliminary study involving patients presenting with frontal sinus cerebrospinal fluid leaks, with defects in the frontal sinus posterior wall, between 2006 and 2010.Setting:Patients were treated in a tertiary referral centre for nose and sinus diseases. Patient records were reviewed and analysed.Results:Nine patients underwent external frontal sinusotomy under endoscopic vision. Repair was successful in all cases, with no complications. Follow up ranged from three months to three years.Conclusion:External frontal sinusotomy and endoscopic repair is a simple, precise and cosmetically acceptable alternative to osteoplastic and major neurosurgical techniques for management of frontal sinus posterior wall defects. This new, previously undescribed technique enables otolaryngologists to play a role in managing such defects.

Download Full-text

Acetazolamide for high intracranial pressure cerebrospinal fluid leaks

International Forum of Allergy & Rhinology ◽

10.1002/alr.21188 ◽

2013 ◽

Vol 3 (9) ◽

pp. 718-721 ◽

Cited By ~ 41

Author(s):

Mohamad R. Chaaban ◽

Elisa Illing ◽

Kristen O. Riley ◽

Bradford A. Woodworth

Keyword(s):

Cerebrospinal Fluid ◽

Intracranial Pressure ◽

Cerebrospinal Fluid Leaks

Download Full-text

Closure of the petrous apex of the temporal bone with ionomeric cement following translabyrinthine removal of an acoustic neuroma

The Journal of Laryngology & Otology ◽

10.1017/s0022215100126301 ◽

1994 ◽

Vol 108 (3) ◽

pp. 202-205 ◽

Cited By ~ 12

Author(s):

J. Helms ◽

G. Geyer

Keyword(s):

Cerebrospinal Fluid ◽

Bone Cement ◽

Temporal Bone ◽

Acoustic Neuroma ◽

Petrous Apex ◽

Cerebrospinal Fluid Leaks

AbstractWhen performing translabyrinthine surgery for acoustic neuroma, the surgeon opens the cerebrospinal fluid space. To prevent the development of post-operative meningitis, the surgical defect should be closed reliably in a watertight fashion. To date, this has been done with success in 12 patients altogether using a self-curing bone cement (ionomeric cement). During follow-up for a maximum of three years there has been no evidence of cerebrospinal fluid leaks.

Download Full-text